Koilonychia in a Patient with Alopecia Areata

Alopecia areata (AA) is an autoimmune disease that affects the hair follicles and leads to nonscarring alopecia. Nails changes are a common manifestation in AA, with an average prevalence of 30 percent. Both nail changes and hair loss in AA are associated with lymphocytic inflammation and are thought to be a result of a loss of immune privilege in both hair follicle and nail apparatus. Koilonychia, or "spoon nails," is a nail dystrophy where the nail plate is depressed centrally and everted laterally. Causes of nail spooning are various, but koilonychia is usually associated with iron deficiency and inflammatory dermatoses, such as psoriasis and lichen planus. Koilonychia is very rarely reported in association with AA in the English literature and its prognostic significance is still unknown. We report a case of a 25-year-old female patient who presented with AA focalis and koilonychia that regressed almost completely after oral corticosteroids, with an accompanying discussion of the pathogenesis and prognostic value of koilonychia.