To the Editor.—
Twenty-nail dystrophy is one of the great scientific riddles of our time. It was described by Samman1 and more recently reemphasized by Hazelrigg.2 It consists of longitudinal ridging, loss of luster, thinning, and distal splitting of all nails. It is most common, but not unique, to childhood and is usually self-limited. Scher et al,3 based on the results of one confirmatory biopsy, concluded that 20-nail dystrophy represented a variant of lichen planus. Wilkinson et al4 also took a biopsy specimen from one patient but found only spongiosis and nonspecific inflammation. Based on their findings, these authors concluded that 20-nail dystrophy was unrelated to lichen planus. Horn and Odom5 described a case persisting years after the resolution of alopecia areata, and they hypothesized that it is a rather nonspecific onychodystrophy of many possible etiologies, including psoriasis.Lichen planus and alopecia areata are both
Person JR. Twenty-Nail Dystrophy: A Hypothesis. Arch Dermatol. 1984;120(4):437–438. doi:10.1001/archderm.1984.01650400019005
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