Median nail dystrophy involving the thumb nail

Abstract

Median canaliform dystrophy of Heller is a rare entity characterized by a midline or a paramedian ridge or split and canal formation in nail plate of one or both the thumb nails. It is an acquired condition resulting from a temporary defect in the matrix that interferes with nail formation. Habitual picking of the nail base may be responsible for some cases. Histopathology classically shows parakeratosis, accumulation of melanin within and between the nail bed keratinocytes. Treatment of median nail dystrophy includes injectable triamcinalone acetonide, topical 0.1% tacrolimus, and tazarotene 0.05%, which is many a times challenging for a dermatologist. Psychiatric opinion should be taken when associated with the depressive, obsessive-compulsive, or impulse-control disorder. We report a case of 19-year-old male diagnosed as median nail dystrophy.

Median canaliform nail dystrophy in a 2‐year‐old boy: Case report and review of the literature

“…20 MCD is diagnosed clinically and is commonly described in the literature as a "fir tree pattern." 8,9,[12][13][14][15][16][18][19][20] Fungal infection should be included in the differential diagnoses and excluded prior to making a diagnosis of MCD. 2,10,15,19 Differential diagnoses can include habit tic deformity and glomus tumors.…”

“…2,10,15,19 Differential diagnoses can include habit tic deformity and glomus tumors. 21 MCD has been reported to improve following cessation or reduction of the inducing agent such as nail trauma, 8,12 isotretinoin, [13][14][15][16][17] aliretinoin, 18 and ritonavir. 2 Reported topical treatments include topical corticosteroids, 12,21 topical tacrolimus, 8,10,11,21 topical urea cream, 12 flurandrenolide tape, 14 and YAG laser.…”

“…19 Systemic therapies include an investigative janus kinase inhibitor 9 or dupilumab. 1 Other treatments include psychiatric counseling 8,10,11 and antipsychotics (Table 10). 10 There are four main species of Tagetes: African, French, Indian and South American marigolds.…”

“…Systemic therapies include an investigative janus kinase inhibitor 9 or dupilumab 1 . Other treatments include psychiatric counseling 8,10,11 and antipsychotics (Table 10) 10 …”

“…7 It is postulated that MCD is induced by trauma, medication, or unknown etiology. Reported modes of trauma include nail biting, 8 from scratching caused by pruritus associated with atopic dermatitis, 9 self-induced with stress or anxiety, [10][11][12] and cryotherapy. 7 Medications that have been reported to induce median canaliform dystrophy include isotretinoin, [13][14][15][16][17] aliretinoin, 18 and HIV treatment ritonavir.…”