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March 1979

Twenty-Nail Dystrophy

Author Affiliations

Oxford, England

Gloucester, England

Arch Dermatol. 1979;115(3):369. doi:10.1001/archderm.1979.04010030067029

To the Editor.—  In the April 1978 Archives (114:612-613), Drs Scher and colleagues reported a case of 20-nail dystrophy with the histological appearances of lichen planus. We have also seen cases of lichen planus, limited to the nails, which simulated 20-nail dystrophy. In one of our patients, histology also showed the typical histological changes of lichen planus. However, another patient (a young boy) had distinctive histological changes that were more "eczematous" in nature and were certainly not compatible with lichen planus. This case is shortly to be published in the British Journal of Dermatology.At present, therefore, we think that "excess ridging"1 of childhood should be regarded as a physical sign and not a disease entity, unless the results of nail biopsy confirm the diagnosis of lichen planus. In other cases that conform to the original description by Hazelrigg et al,2 and where there is no evidence of

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