Nail Dystrophy (alopecia areata)

Diagnosis: Nail Dystrophy (alopecia areata)

A linear arrangement of pits may occur in a longitudinal manner.

Clinical Presentation

A linear arrangement of pits may occur in a longitudinal manner.

Clinical History

Submitted by Alaa Saad. Originally posted October 20, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Median nail dystrophy • Lichen planus (nail) • Psoriatic nail dystrophy • Onychomycosis • Darier disease (nail)

Key Learnings

• Central longitudinal ridge with horizontal grooves on thumbnail — "washboard" or "fir tree" pattern • Caused by habitual picking/pushing of proximal nail fold/cuticle • Most common on thumbnails — bilateral involvement common • Diagnosis is clinical — patient often unaware of the habit • Enlarged lunula (from chronic cuticle manipulation) is a clue • Completely reversible if the habit stops

Tags: nail, dystrophy, alopecia, areata, alaa saad