A Case of Idiopathic Twenty-Nail Dystrophy

In children, nail diseases can be either congenital or acquired, with an occurrence rate of 3 to 11% in the pediatric population. In both fingers and toes, rough, accentuated linear ridges of the nails are referred to as trachyonychia. This condition most commonly occurs in childhood, with a higher prevalence in males. Twenty-nail dystrophy refers to a disorder affecting all twenty nails. While the cause is idiopathic, it may also be associated with other dermatological conditions. The disorder typically affects the nails on both hands and feet in a bilateral and symmetrical pattern. The primary concern for the child is usually cosmetic disfigurement, requiring regular follow-up and long-term care. In this case report, we describe a 10-year-old boy who presented with a six-year history of twenty-nail dystrophy, with no significant family history of skin or nail diseases. The child exhibited no other symptoms aside from alopecia areata. This condition is self-limiting and is managed symptomatically. This case report aims to highlight the importance of physical examination in the early diagnosis and treatment of nail disorders.