Trachyonychia in a child with concomitant alopecia areata and lichen planus

Abhinav David, Inderpreet Kaur


Trachyonychia of nails has been found to be associated with dermatoses such as lichen planus, psoriasis, alopecia areata etc. When involving all the finger and toe nails bilaterally, it is referred to as ‘twenty nail dystrophies. We, hereby, report a case of trachyonychia in an 8-year-old boy, with concomitant lichen planus and alopecia areata. He was successfully treated with biweekly pulse systemic corticosteroid therapy for duration of 6 months. Significant response was noted at the end of 6 months in terms of hair re-growth; improvement of nail texture, thickness and subungual hyperkeratosis; and resolution of skin lesions.


Twenty nail dystrophy, Trachyonychia, Lichen planus, Alopecia areata

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Gordon KA, Vega JM, Tosti A. Trachyonychia: a comprehensive review. Ind J Dermatol Venereol Leprol. 2011;77:640-5.

Haber JS, Chairatchaneeboon M, Rubin AI. Trachyonychia: Review and Update on Clinical Aspects, Histology, and Therapy. Skin Appendage Disord. 2017;2(3-4):109-15.

Kanwar AJ, Ghosh S, Thami GP, Kaur S. Twenty-nail dystrophy due to lichen planus in a patient with alopecia areata. Clin Exp Dermatol 1993;18:293-4.

Chelidze K, Lipner SR. Nail changes in alopecia areata: an update and review. Int J Dermatol. 2018;57(7):776-83.

Tosti A, Piraccini BM, Cambiaghi S, Jorizzo M. Nail lichen planus in children: clinical features, response to treatment, and long-term follow-up. Arch Dermatol. 2001;137(8):1027-32.

Anggowarsito JL, Kandou RT. Trachyonychia associated with alopecia areata and secondary onychomycosis. J Biomedik. 2014;6:50-59.

Oztaş P, Onder M, Ilter N, Oztaş MO. Childhood lichen planus with nail involvement: a case. Turk J Pediatr. 2003;45(3):251-3.

Nischal U, Kharkar V. Different treatment modalities in the treatment of childhood lichen planus. Indian J Drugs Dermatol. 2016;2:87-92.

Peluso AM, Tosti A, Piraccini BM, Cameli N. Lichen planus limited to the nails in childhood: case report and literature review. Pediatr Dermatol. 1993;10(1):36-9.

Starace M, Alessandrini A, Bruni F, Piraccini BM. Trachyonychia: a retrospective study of 122 patients in a period of 30 years. J Eur Acad Dermatol Venereol. 2020;34(4):880-84.

Peloquin L, Castelo-Soccio L. Alopecia Areata: An Update on Treatment Options for Children. Paediatr Drugs. 2017;19(5):411-22.