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Alopecia Areata — SCE Dermatology MCQ

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HardNail DisordersAlopecia AreataSCE Dermatology

A young adult has patchy non-scarring scalp alopecia with exclamation-mark hairs. All fingernails are rough, thin and longitudinally ridged, producing a sandpaper surface. Which associated nail disorder is most likely?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Alopecia-areata-associated trachyonychia affecting multiple nail matrices

Explanation lettering: C = shown as B · D = shown as C · E = shown as D · B = shown as E

E is correct. Trachyonychia describes rough, thin, longitudinally ridged nails and may accompany alopecia areata, especially when many nails are involved. The simultaneous patchy non-scarring alopecia and exclamation-mark hairs make that association most likely. Darier disease classically gives V-shaped distal nicking and longitudinal red-white streaks; psoriasis more often causes pitting, onycholysis and subungual hyperkeratosis; lichen planus may scar the matrix and form pterygium; and onychomycosis generally produces asymmetric crumbly dystrophy confirmed mycologically.

Reference: BAD alopecia areata living guideline 2024: https://academic.oup.com/bjd/article/192/2/190/7829170