Common Nail Disorders
Section snippets
Psoriasis
Approximately 1% to 2% of the general population has psoriasis, and nail changes are found in approximately 12% of these patients [1]. Examination of the nail often is helpful in establishing the diagnosis of psoriasis. If, for example, the skin examination reveals a scaly, erythematous, patchy rash on the arms and legs, the presence of nail pitting might indicate psoriasis rather than eczema in that individual.
Lichen planus
Lichen planus presents as pruritic papules on the volar wrists and extremities. Mucosal lesions in the mouth and genitalia are common. It may be associated with nail changes, but nail changes occur more often as an isolated finding [19].
Alopecia areata
Nail changes in alopecia areata may be more common than originally thought. If the nails in these patients are examined closely, nail findings may be seen in up to half of alopecia areata patients; nail plate pitting is the most common observation [27]. Nail changes may be seen in patients who have alopecia areata of the scalp but are more common and more severe in alopecia universalis. Alopecia areata also may present as an isolated finding, present only in the nails.
Twenty-nail dystrophy
Hazelrigg and colleagues [33] originally described twenty-nail dystrophy of childhood in children who had acquired trachyonychia of all 20 nails. This condition was observed in children from 18 months to 18 years of age in the absence of a skin condition or disease. Since the original description in children, twenty-nail dystrophy also has been observed in adults [34]. The nail changes usually resolve over several years, although a few cases have persisted into adulthood [7]. Twenty-nail
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