Trachyonychia: a retrospective study of 122 patients in a period of 30 years

Abstract

Background Trachyonychia is a nail disease characterized by longitudinal striations, ridges, fissures and/or pitting. This condition can be both idiopathic and associated with other dermatologic diseases. Objective and methods The aim of this retrospective study was to analyse the clinical features, onychoscopy, therapy efficacy and outcome of 122 patients with trachyonychia visited at the Hair Disease Outpatient Consultations of the Dermatology Unit of the Department of Experimental, Diagnostic and Specialty Medicine of the University of Bologna, from 1988 to 2018. Results Opaque trachyonychia was the most observed type while shiny trachyonychia, less common, was present especially in milder cases. Pitting was the most frequently observed feature (80.3%), followed by koilonychia (45%) and hyperkeratosis (19.6%). Nail matrix longitudinal biopsy was performed for diagnosis confirmation in 29 cases, and spongiotic was the most common pattern. Topical therapy was prescribed in 109 patients while systemic treatments were reserved for severe cases (38 patients); 22 patients did not receive any treatment. A marked improvement in the appearance of the nails or even a total resolution was seen in 63 patients. Conclusions Trachyonychia can occur at any age but is more frequent in children and often associated with alopecia areata. The pathological diagnosis of trachyonychia is not mandatory as the disease has generally a benign outcome. Considering the absence of pain and the high rate of spontaneous resolution, treatment is often prescribed only for cosmetic reasons or reserved for severe cases.

A fresh look at the histopathology of trachyonychia

“…Significantly lower percentages were seen with patients demonstrating the psoriasiform pattern (16.7%), lichenoid pattern (13.3%), and a non‐specific pattern (16.7%). These data support what has been shown in prior literature 2,3 : that the spongiotic pattern is by far the most prevalent histopathologic pattern identified in trachyonychia. The psoriasiform and lichenoid patterns have also been identified with trachyonychia in prior literature, with some degree of variability from what is reported in the study by Hur et al However, the data presented by Hur et al confirm that these other two histopathologic patterns occur with substantially lower frequency.…”

“…Trachyonychia is a non‐scarring process, and can spontaneously resolve or improve on its own (although this may take years), or with a variety of therapies 2‐4 . Thus, nail unit biopsies for this condition are generally disfavored because the potential risks of the procedure can outweigh the benefits.…”

Histopathologic findings of idiopathic trachyonychia: An analysis of 30 adult patients

“…Recently, the same institution examined the nail matrix tissues of 29 trachyonychia cases, which is the largest pathological study to date 6,7 . They showed that 21 cases (72.4%) had spongiotic changes, 5 (17.2%) with psoriasiform pattern, and 3 (10.3%) with histopathologic features of the lichen planus 7 . Our histopathologic analysis data revealed lymphocytic infiltrates in the majority of cases (93.3%).…”

“…Inflammation severity affects both the subtype and number of involved nails. Starace et al reported that among 122 trachyonychia patients, opaque trachyonychia was detected in more severe cases with involvement of approximately 13.4 nails, while shiny trachyonychia was detected in milder cases with approximately 1.6 nails involved 7 …”

“…Histopathology of nail biopsy specimens revealed spongiotic changes, psoriasiform features, and lichen planus in 19, 3, and 1 case, respectively. Recently, the same institution examined the nail matrix tissues of 29 trachyonychia cases, which is the largest pathological study to date 6,7 . They showed that 21 cases (72.4%) had spongiotic changes, 5 (17.2%) with psoriasiform pattern, and 3 (10.3%) with histopathologic features of the lichen planus 7 .…”