Twenty-nail dystrophy, sometimes called Sandpapered nails, is a specific type of Trachonychia, and is characterized by the rough accentuated linear ridges (longitudinal striations):658 developed on all of the twenty nails of the fingers and toes. Restated, all twenty nails may become opalescent, thin, dull, fragile, and finely longitudinally ridged, and, as a result, distally notched.:783 If the symptoms are not on all twenty nails, then the condition is just referred to as Trachonychia. It can be a manifestation of lichen planus, psoriasis, alopecia areata, immunoglobulin A deficiency, atopic dermatitis, and ichthyosis vulgaris.
"The longitudinal striations can occur as a normal part of the aging process," and not until the nails start to thin and get that sandpaper look is the condition even called trachonychia. The nails are opalescent and frequently are brittle and split at the free margin. There has been evidence of the condition as a cutaneous manifestation of lichen planus. It has also been associated with other diseases such as eczema, psoriasis, alopecia areata, atopic dermatitis. Twenty-nail dystrophy and Trachonychia is often seen in vitiligo patients suggesting that they are more susceptible to this condition.
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