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Trachyonychia — SCE Dermatology MCQ

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HardNail DisordersTrachyonychiaSCE Dermatology

A 30-year-old woman has nail changes showing longitudinal ridging (onychorrhexis). This is a common finding in lichen planus. When all 20 nails are affected with longitudinal ridging and become rough and lustreless, what is the term?

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Correct answer: E — Twenty-nail dystrophy, also termed generalised trachyonychia

The best answer is “Twenty-nail dystrophy, also termed generalised trachyonychia”. Nail findings localise disease to matrix, bed or periungual tissue; a new changing longitudinal pigmented or erythronychic band requires specialist assessment because benign and malignant causes overlap. The alternatives “Dorsal pterygium from scarring nail-matrix disease”, “Onycholysis from separation of the distal nail plate”, “Onychomadesis after temporary arrest of matrix growth”, “Median canaliform dystrophy from repetitive matrix trauma” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: DermNet specialist nail terminology reference: https://dermnetnz.org/topics/nail-terminology