Nail Dystrophy in a Teenager

Abstract

Median nail dystrophy is a rare acquired nail disorder usually involving one or both thumb nails. It is characterised by a median or paramedian longitudinal groove with multiple parallel transverse grooves originating from it, giving an ‘inverted fir tree’ appearance. In majority of the cases, no cause can be found but self-inflicted trauma and oral retinoids have been hypothesised as inciting factors in some cases. Nail plate changes similar to median nail dystrophy can be seen in habit tic deformity, digital myxoid cyst etc. but careful clinical examination is usually sufficient to arrive at the diagnosis. Median nail dystrophy can remit spontaneously over a period of months to years or be persistent. Topical tacrolimus 0.1% and tazarotene 0.05% have been found to be effective in some cases. A psychiatrist consultation should be sought if the history of obsessive compulsive disorder or impulse control disorder is forthcoming.