Trachyonychia is a condition that affects the nails on both the toes and the fingers, also known as sandpapered nails. Linear longitudinal striations appear on the nails, very deep and with a rough surface. A variety of this condition is the so-called twenty-nail dystrophy, when all of the nails of both hands and feet are damaged. This affects males more often than females and is more severe at a young age.

The disease weakens the structure of nails, making them thinner, fragile, dull and with an opalescent color. As a result, indentations and linear ridges start to develop. This can be the consequence of many possible diseases such as atopic dermatitis, ichthyosis vulgaris, lichen planus, psoriasis, alopecia areata or deficiency of immunoglobulin A.

It must be said however that such longitudinal marks are also normal with aging, so their presence is not the only sign of the disease. It is only considered a trachyonychia case when the nails become rough like sandpaper and thinner than normal. They also turn opalescent and fragile, with the edges susceptible to splitting. In some cases, the condition is one of the effects of lichen planus. It can also be caused by other skin problems like atopic dermatitis, eczema, psoriasis or alopecia areata. Vitiligo seems to greatly increase vulnerability to trachyonychia, since many patients can have both conditions.

The rough nails disease can occur as a separate disorder or combined with other diseases, usually the ones that affect the skin. Trachyonychia is classified in two separate varieties. The more severe type causes nails to become rough in texture and lose their transparency. The mild variety only makes nails shiny, covered with shallow lines.

Since most of the time the disease has no other symptoms and is not connected with other conditions, its real cause is unknown. In cases when it is linked with another disease, this is usually a skin illness like eczema, psoriasis or alopecia areata. Even if the exact mechanism is not known, some scientists think that trachyonychia might be the result of such skin conditions.

A link between trachyonychia and baldness has been established but it is unclear how these problems are connected or if one causes the other. What is certain is that people who suffer from rough nails also lose their hair. However, baldness can be minor or extensive. The severe hair loss cases are usually the effects of a disease named alopecia areata.

There also appears to be a degree of genetic transmission. In some families, the problem is passed on in the so-called autosomal dominant fashion. Spontaneous cases of trachyonychia are very rarely reported in medical literature but their real number is believed to be a lot higher. This is because trachyonychia is not easy to diagnose without the presence of other symptoms and its root cause is mostly unknown.

Symptoms of trachyonychia

The nails usually lose their glow and are covered with ridges. In severe cases, the surface becomes extremely rough, resembling sandpaper. Sometimes, the nail becomes very shiny. A closer inspection reveals numerous tiny holes on its surface, causing this appearance.

Diagnosis of trachyonychia

The disease is easy to recognize due to its trademark symptoms. It usually begins during childhood but it can sometimes start during adulthood as well. The symptoms are normally quite obvious. The nails get damaged and usually develop ridges, or areas of alternative raised and depressed zones. They can also become opaque, change color to a dirty white one, split at the edges or become rough like sandpaper.

In order to establish a clear pathological diagnosis, more complex investigations are required. Since this is a benign disease, including the cases when the cause is lichen planus, this is not really needed. The methods used are either a longitudinal nail biopsy or a nail matrix punch.

As for the histopathologic features encountered in cases of trachyonychia, the most common are exocytosis of inflammatory cells into the nail epithelia and spongiosis. In some cases, the features are just like the ones of psoriasis or lichen planus.

Treatment of trachyonychia

Trachyonychia usually needs no treatment because it doesn't cause any other symptoms. There is no really effective treatment for it anyway. Many cures have been attempted with various grades of success, these include topical PUVA, systemic corticosteroids, tazarotene and oral antifungals. When trachyonychia is linked to a skin disease, the treatment for it seems to have no effect on the nails. However, Elma 09 Nail Ointment treatment can help as it fights fungus and speeds up the growth of the nail.