Longitudinal Ridging Research Articles

Overhauling dental implications in a child with rare craniofrontonasal syndrome: a case report

Craniofrontonasal syndrome is an extremely rare X-linked dominant genetic disorder characterized by features such as hypertelorism, craniosynostosis, ocular anomalies, a bifid nasal tip, and longitudinal ridging with splitting of the nails. Heterozygous females are more severely affected, presenting frontonasal dysplasia and coronal craniosynostosis (fusion of the coronal sutures), while males typically only exhibit hypertelorism. This case report describes the dental management of a 9-year-old female with craniofrontonasal syndrome who was referred to the department of paediatric and preventive dentistry for pain in the lower right and left back tooth region. The patient exhibited a clinical spectrum including microcephaly, short neck, axillary pterygium, clinodactyly of the toes, longitudinal ridging with split nails, pectus excavatum, and underdeveloped female genitalia. Extraoral examination revealed hypertelorism, flat nasal bridge, low-set ears, strabismus, antimongoloid slant, and an indistinct philtrum. Intraoral examination showed a high palatal vault, crowding of the upper and lower arches during the mixed dentition period, multiple dental caries, and poor oral hygiene. An orthopantomogram confirmed delayed dental development. Dental treatment was carried out on a dental chair system using adequate behaviour management techniques with short appointments, keeping in mind the reduced cooperative ability of the child. The importance of this report stems from the limited dental literature available on the syndrome. Preventive measures along with home care instructions were emphasized to support professional care.

Alopecia Areata of the Nails: Diagnosis and Management.

Background: Alopecia areata (AA) is a common form of non-scarring alopecia characterized by acute hair loss. Nail involvement, though not always present, can occur in AA patients. Nail changes are more frequent in severe forms of AA and in children. Methods: Literature related to nail changes in AA was comprehensively reviewed after a search on the PubMed database without time restrictions in order to identify common clinical presentations and associated factors to aid clinicians with the correct evaluation and management of these dystrophies. Results: Nail changes in AA include pitting, trachyonychia, leukonychia, red lunula, and miscellaneous alterations such as longitudinal ridging and brittle nails. Nail changes are usually asymptomatic but, nevertheless, sometimes cosmetically disfiguring and can be associated with a reduced quality of life and impaired daily activities. Conclusions: Nail changes in AA may precede or follow hair loss and can occur as an isolated finding. Diagnosis may require a biopsy for definitive identification. Spontaneous improvement is possible, particularly in children, and treatment is not always necessary. Further research is, however, needed to establish a consensus on treatment approaches according to age and severity.

Trachyonychia in Children: A Comprehensive Review with Recent Updates

Trachyonychia also known as 20-nail dystrophy presents as roughness of nail plate associated with longitudinal ridging giving a sandpaper-like appearance. It has two subtypes: opaque variety and shiny variety. It commonly presents in the pediatric age group 3–12 years but can present at any age. It can be idiopathic or associated with cutaneous or systemic conditions. Alopecia areata, atopic dermatitis, vitiligo, and lichen planus are some of the commonly associated conditions. Diagnosis is clinical and in doubtful cases, biopsy has a role. Onychoscopy as a novel diagnostic modality can be used. Spontaneous resolution is seen in the majority of pediatric patients, so counseling, reassurance, and active nonintervention can be tried. Treatment is mainly for cosmetic concerns or when associated with some systemic conditions. Various treatment modalities are available with variable efficacy. Topical treatment options include tazarotene, topical steroid, and calcipotriol/betamethasone combination, whereas systemic agents such as oral mini-pulse steroid, methotrexate, cyclosporine, and low-dose acitretin have shown beneficial role. Novel treatment modalities such as the use of tofacitinib, fluocinonide 0.05% with bifonazole 1% cream, combination of fractional CO2 laser with topical therapy, and alitretinoin have shown promising results.

Onychocytic Matricoma: A Clinical, Dermoscopic, and Pathological Analysis of 14 Cases.

Onychocytic matricoma (OCM) is a benign neoplasm of the nail matrix. Only 18 cases of this tumor have been reported in the literature to date. We retrospectively analyzed the clinical features of 14 patients with OCM. The most common clinical feature was longitudinal xanthopachyonychia (n = 9), followed by longitudinal leukopachyonychia (=3) and longitudinal pachymelanonychia (n = 2). The most common clinical findings identified following dermoscopy and analysis at high magnification of classical photographs were free-edge thickening of the nail plate without pitting (n = 14), longitudinal ridging (n = 7), round white clods (n = 7), white dots (n = 7), and filiform hemorrhages (n = 7), followed by oval and linear white clods (n = 5), fuzzy lateral border (n = 5), and red-purple blood clods (n = 3). Nail clipping histopathology showed a thickened nail plate with multiple, small, round-to-oval spaces. The tumor expressed immunopositivity for LEF-1. Dermoscopy of the nail plate and nail clipping histology provides useful information with regards to the differential diagnosis with subungual squamous cell carcinoma and nail melanoma. Ex vivo-in vivo correlation facilitates a better dermoscopic assessment of this unique underrecognized disease. However, the differential diagnosis between OCM and onychocytic carcinoma requires biopsy of the tumor. LEF-1 as an onychogenic marker can be used to resolve the differential diagnosis between OCM and subungual longitudinal acanthoma/seborrheic keratosis.

Nail involvement in connective tissue diseases: an epidemiological, clinical, and dermoscopic study.

The assessment of nail changes in connective tissue diseases (CTD) has been rarely explored in previous studies. The use of dermoscopy to study vascular changes in nailfolds is an interesting diagnostic technique. The aim of the study was to describe the epidemiological, clinical, and dermoscopic features of nail lesions in CTD. A prospective study was performed at the Dermatology Department of Habib Thameur Hospital (Tunis, Tunisia) in collaboration with the Internal Medicine Department over a period of 15 months, from July 2020 to September 2021, including patients diagnosed with systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis (DM). Our study included 48 patients. Nail involvement was found in 44 cases. Dermoscopic nailfold abnormalities were identified in 37 cases. The most common clinical features were ragged cuticle, nailfold erythema, and onycholysis. Additionally, splinter hemorrhage, longitudinal ridging, lunula abnormalities, melanonychia, trachyonychia, leukonychia, increase in transverse curvature, parrot beak nail, half and half nails, and onychorrhexis were described. Nailfold dermoscopy showed a normal pattern in 10 cases, a nonspecific pattern in nine cases (SLE), and a scleroderma pattern in 29 cases (SS and DM). The scleroderma pattern was further categorized into an early pattern (6), an active pattern (14), and a late pattern (9). Normal pattern was observed solely in patients in remission. The late scleroderma pattern was associated with disease duration and systemic involvement. In SLE, disease activity correlated with onycholysis, nailfold erythema, and pathologic pattern in dermoscopy. However, patients with DM displayed a positive correlation between pulmonary involvement and scleroderma pattern. Nail involvement in CTD includes a diverse range of abnormalities. Despite being nonspecific, it can provide crucial clues for establishing a diagnosis. Nailfold dermoscopy serves as a mirror for microangiopathy, enabling the detection of changes at an initial stage, and thus, it becomes a diagnostic and prognostic tool.

A Descriptive Study of Nail Changes in Systemic Diseases

Abstract Background and Objectives: Nail findings may represent a part of the symptom complex that may be useful for the physical diagnosis. Thus, the present study was undertaken to know the nail changes in systemic diseases among patients attending the outpatient and inpatient departments of dermatology, medicine, nephrology, pulmonology, and surgery attached to Karnataka Institute of Medical Sciences (KIMS), Hubballi. Methodology: A hospital-based original study was conducted at KIMS, Hubballi. During January 1, 2021–January 30, 2023, data were collected by personal interview after obtaining informed consent from all eligible participants using a prestructured and pretested pro forma, among a convenient sample of 272 patients selected by the simple random sampling method. Results: Among 272 patients, 57.5% of the patients were young adults with male predominance (56.0%) and inpatients (66.0%) were more compared to outpatients (44%). Of the 272 patients, respiratory system (RS) (26%) was most common involved followed by hematology (21.0%), gastrointestinal tract (GIT) and liver (17%), cardiovascular system (CVS) and renal (12%), and clubbing was the most common nail change encountered (35.5%) followed by longitudinal ridging (33%) and pallor (31%) of the nail subsequently. RS was found as the common cause of clubbing followed by CVS and liver and GIT. Conclusion: RS (clubbing) was the most common system involved. Other systems involvement were renal system (half and half nail), liver, and GIT system (Terry’s nail) which are the specific nail changes that can lead us to the diagnosis. Thus, nails can serve as a window for the underlying systemic illness.

A Rare Case of Nail Lichen Planus

Background: Nail lichen planus (NLP) is often associated with the involvement of other mucocutaneous sites. Though isolated nail involvement can be seen in a number of cases, it is seen in up to 10% of cases. Nail lichen planus is a rare case. This is the first case in the last 5 years in the dermatology and venereology department of Dr. M. Djamil Hospital Padang.
 Case presentation: A 26 years old woman came to the Dermatology and Venereology Department at Dr. M. Djamil Hospital Padang with all of her fingernails and toenails ridging, thinning, and brittle, and the color became yellow brown-blackish that worsened 6 months ago. This complaint had been suffered for 5 years ago. Dermatological examination showed onychodystrophy, longitudinal ridging and fissuring, yellow-brownish blackish discoloration on all fingernails and toenails, and there were no skin and mucosa lesions. The dermatology life quality index (DLQI) patient was 8. Potassium hydroxide (KOH) examination and fungal culture were negative. Histopathological examination showed hypergranulosis and sawtooth rete ridges. The patient was treated with clobetasol propionate 0,05% ointment with occlusion twice per day and showed improvement.
 Conclusion: Nail lichen planus can occur in the absence of skin or mucosal involvement. In this case, there is no skin or mucosal involvement. The diagnosis in this case is based on clinical, dermoscopic, and histopathological examination.

Twenty‐nail dystrophy and alopecia areata in an adult male with thymoma‐associated myasthenia gravis: A case report

AbstractBackgroundTo date, there is no journal that reports the coexistence of thymoma‐associated myasthenia gravis, alopecia areata, and twenty‐nail dystrophy. This paper hypothesizes that the presence of thymoma increases the risk of these conditions.Case presentationThe patient was a 37‐year‐old Filipino who came in for a year of history of fluctuating, but progressive, left‐sided ptosis and diplopia; difficulty swallowing; dysarthria; and aspiration and symmetric proximal muscle weakness confirmed to be myasthenia gravis by abnormal repetitive nerve stimulation and the presence of thymoma on histology. Before his thymectomy, he also developed gradually worsening thinning and longitudinal ridging of all fingernails and toenails; and patches of bald areas on the scalp; diagnosed to be twenty‐nail dystrophy and alopecia areata, respectively, by a board‐certified dermatologist.ConclusionThymoma is the possible risk factor and link for the co‐occurrence of the three conditions in the present patient.

The role of dermoscopy in the diagnosis of nail affection of psoriasis and lichen planus

Background Nail disorders comprise ∼10% of all dermatological conditions. Because diagnosis is not always possible by clinical means alone, additional diagnostic procedures may be required at times. Dermoscopy of nails (onychoscopy) has shown promising results in diagnosing various nail disorders. Aim To study the dermoscopic nail findings in psoriasis and lichen planus. Patients and methods A total of 80 patients with clinically evident psoriasis and lichen planus of nail were included in this study. They were classified into two groups: group 1 included 40 patients with nail psoriasis and group 2 included 40 patients with nail lichen planus. All patients were examined clinically and by dermoscope for criteria of psoriasis and lichen planus of the nails. Results In psoriatic patients, pitting is the commonest finding observed clinically and by dermoscope. Splinter hemorrhage, pitting, leukonychia, longitudinal ridging, oil drop sign, and onycholysis are better visualized by dermoscopy, and dilated hyponychial capillaries are detected only by dermoscopy. In patients of lichen planus, longitudinal ridging is the commonest finding observed clinically and by dermoscopy. Longitudinal ridging, pitting, chromonychia, and splinter hemorrhage are better seen by dermoscopy. Linear dyschromic bands are not detected clinically. Conclusion Onychoscopy can provide valuable diagnostic information in cases of nail psoriasis and nail lichen planus.

Efficacy of Fluocinonide\Bifonazole Cream for the Treatment of Trachyonychia: A Retrospective Case Series.

Trachyonychia is a benign nail condition, most commonly seen in children. Trachyonychia manifests as excessive longitudinal ridging, nail roughness, and nail brittleness. Treatment is sought mainly for esthetic reasons as well as functional reasons. A number of therapeutic approaches exist, mainly based on case reports or small non-comparative case series. To report treatment outcome among patients with trachyonychia. A retrospective case-series study was conducted among patients who were treated trachyonychia between years 2017 and 2020. Patients were prescribed fluocinonide 0.05% with bifonazole 1% cream, applied with or without occlusion, and methylprednisolone 1-2 mg/nail, injected into the involved nail matrix, or oral cyclosporine 3 mg/kg. Complete response (over 90% improvement) and partial response (over 50% improvement) were assessed. A total of 43 patients with trachyonychia were included [mean age 10.0 years (±5.7), 69.8% males, mean disease duration 4.7 years (±3.0)]. In 90.7% of the cases, topical fluocinonide\bifonazole cream was prescribed. Under-occlusion topical application was found to be highly effective, achieving complete response in 35.3% and partial response in an additional 52.9% of the patients. Occluded application was also found to be significantly more effective than non-occluded application. Treatment efficacy was not affected by the severity of nail roughness, trachyonychia morphology, or whether trachyonychia was idiopathic or coexisted with other dermatological conditions. Occluded application of fluocinonide plus bifonazole cream is efficient for the treatment of trachyonychia and should be considered a first line of treatment.

Tofacitinib for the Treatment of Twenty-Nail Dystrophy: A Single Case Report.

Twenty nail dystrophy refers to the condition of trachyonychia affecting all the twenty nails. The term trachyonychia is used to describe thin brittle nails with excessive longitudinal ridging. Treatment of twenty nail dystrophy is difficult due to poor bioavailability of drugs in nails. Tofacitinib is novel JAK-STAT inhibitor that has been used successfully for the treatment of nail dystrophy with alopecia areata suggests the possibility of the drug being used for twenty nail dystrophy.

The Effects of the Oral Supplementation with a Natural Keratin Hydrolysate (Kera-Diet®) on Hair and Nails: Randomized, Placebo and Benchmark-Controlled Clinical Trial on Healthy Females

Background Telogen effluvium (TE) and its acute form (aTE) are two of the commonest occurrences in a trichology clinic, with patients claiming excessive hair shedding. ATE can occur in people of any age and ethnicity and is considered to be a quite common condition in either sex even if women are more likely to have a lowered quality of life and restricted social contacts as compared to men as a result of hair loss. Brittle nail syndrome (BNS) is a common condition affecting up to 20% of the population, especially women over 50 years of age. Nails affected by BNS appear ragged, thin, and dull. The clinical features of BNS include horizontal splits within the nail plate (onychoschizia) and increased longitudinal ridging or splitting (onychorrhexis). In BNS oral supplementation, trace elements and amino acids (especially L-Cystine) have been reported to be useful to ameliorate the nail plate condition. Objective We hypothesized that a nutritional approach, with nutrients of which the composition is close to the human keratin, could be effective to decrease hair loss during telogen effluvium and to improve brittle nails condition. At this purpose, a clinical study was designed to investigate the efficacy of a natural keratin hydrolysate obtained from a non-human source (feathers) on both aTE and BNS. Methods The in vivo effects of a natural keratin hydrolysate, Kera-Diet® (KD) upon human hair and nails condition was tested in a randomized, double-blind, parallel-group, benchmark (BE) and placebo (PL) controlled study involving 60 women during 90 days. In all subjects, Anagen/Telogen hair, hair volume and density, pull test, global photography, hair and nails brightness, and nail plate growth were measured at baseline and after 45 and 90 days of products use. A self-assessment test was carried out at the end of the study. Results With the KD treatment group, hair density, percentage of hair in anagen phase, hair and nails brightness, and nails growth were significantly increased compared to PL treatment group. Interestingly, with this same group, the diagnosis of aTE by pull testing was negative from 45 days. The efficacy of KD was equal to or greater than PL treatment group. Conclusion In this study, we demonstrated that daily oral administration of 1000 mg during 3 months of a natural extensively keratin hydrolysate, Kera-Diet®, associated to trace elements and specific vitamins was effective to improve both hair and nails condition. Furthermore, it demonstrates the role of nutrients in both aTE and BNS.

Simultaneous occurrence of idiopathic trachyonychia in dizygotic twins.

Trachyonychia (or twenty-nail dystrophy) is an uncommon chronic disorder manifesting as thin, flattened, brittle nails with excessive longitudinal ridging and loss of luster creating a "sandpaper-like" texture that most commonly presents spontaneously in childhood as an isolated phenomenon; however, it has been historically associated with numerous dermatoses. Rarely, trachyonychia has been reported to occur in families, suggesting a potential hereditary predisposition. We report trachyonychia occurring simultaneously in dizygotic twins, further supporting a possible underlying genetic basis of this idiopathic nail disorder.

Muco-cutaneous manifestations of chronic kidney disease with or without hemodialysis

<p class="abstract"><strong>Background:</strong> Mucocutaneous manifestations significantly impair the quality of life of patients with chronic kidney disease (CKD) but are usually understudied. Our objective was to study the patterns and prevalence of mucocutaneous and nail involvement in CKD patients and to compare those in patients with or without haemodialysis.</p><p class="abstract"><strong>Methods:</strong> Ninety patients aged 18-80 years having CKD (M: F=1.64:1) since mean duration of 4.43±9.9 months were studied in an observational cross-sectional study. Sixty-two (68.9%) patients were on hemodialysis since 42.64±63.14 months. Detailed history and examination, and relevant investigations like KOH mount, skin biopsy, gram stain and culture were done when required. Data was analyzed using SPSS version 21 software. Relevant tests were applied, p<0.05 was considered statistically significant.<strong></strong></p><p class="abstract"><strong>Results:</strong> Xerosis in 43 (47.7%), pruritus in 26 (28.9%), ichthyosis in 11 (12.2%), and skin pallor in 7 (7.8%) patients were major dermatoses. Xerosis was more commonly found in patients on haemodialysis (37.8%) as compared to those without dialysis (9.9%) (p-0.046). Bullous lesions, perforating folliculitis and foot ulcers occurred in 1 (1.1%) patient each. Common nail abnormalities were longitudinal ridging (21.1%), leukonychia (13.3%), Lindsay’s half‐and‐half nails (4.4%) and dystrophic nails (4.4%). Mucosal manifestations were coated tongue (2.2%%), angular cheilitis (2.2%), and pigmented tongue (1.1%).</p><p class="abstract"><strong>Conclusions:</strong> Xerosis, pruritus, ichthyosis skin pallor, longitudinal ridging, leukonychia, coated tongue, and angular cheilitis were the common mucocutaneous manifestations in our study. Early recognition and management of these dermatoses plays a crucial role in a holistic patient treatment, reduce disease morbidity and improve their quality of lives.</p>

Nail Changes in Lichen Planus: A Single-Center Study.

Lichen planus (LP) is an inflammatory condition that can affect skin, mucous membranes, hair follicles, and/or nails. Nail abnormalities are estimated to occur in around 10% of LP cases. Clinical characteristics of nail involvement have been the subject of very few studies, which have mainly focused on isolated nail LP. To identify and describe nail alterations in patients with LP. Seventy-five patients with cutaneous lichen planus (CLP) were included in the study. The diagnosis of LP was histologically confirmed in each case. Onychomycosis was excluded in each patient. Nail lesions were present in 21 (28%) patients (mean age 58.1 ± 12.55 years) with CLP. On an average, patients had 9.38 nails affected. A slight female preponderance was noted (57%). Nail involvement was independent of age, gender, presence of pruritus, the affected skin area, or the duration of CLP. The most common finding in the fingernails (n = 122) was longitudinal ridging (85.2%), followed by nail plate thinning (38.2%) and onycholysis (17.2%). Pterygium formation (6.6%) and red lunulae (8.2%) were limited to the fingernails. In the fingernails, matrix involvement (98.4%) was more frequent than nail bed involvement (27%). The most common finding in the toenails (n = 75) was hyperkeratosis (82.7%) with yellowish discoloration (69.3%). No cases of trachyonychia or anonychia were noted. Nail abnormalities in patients with CLP may be more common than initially assessed. Rare formation of pterygium and absence of anonychia in patients with predominant cutaneous involvement might point at mild course of the nail disease in such cases.

Dermatological Manifestations in Patients of Chronic Kidney Disease (CKD)

Background: CKD is associated with various mucocutaneous manifestations that impair the quality of life.The objective was to study the incidence of various cutaneous manifestations in CKD patients.Materials and Method: 130 (M:F = 4.2:1) patients aged 15?78 (Mean age- 50.32 years) having CKDfor 3 month to 5 years were studied for mucocutaneous manifestations. Forty (30.7%) patients were onhemodialysis for 1-3 months. Detailed medical history, clinical and mucocutaneous examination and labinvestigations were performed. KOH mounts, skin biopsy, Gram’s and Giemsa staining, bacterial or fungalcultures were performed as required.Results: Xerosis in 104 patients (80%), skin pallor in 76(58.4%), pruritus in 52 (50.9%) patients, pigmentationin 45(34.6%) and purpura in 12 (9.2%) patients were the major dermatoses. Perforating folliculitis occurredin1 (0.76%) patient..Mucosal findings included coated tongue in14(11.66%), xerostomia in 11(9.16%) andmacroglossia with teeth markings and fissured tongue in 9 (7.5%) patients each, angular cheilitis in 3 (2.5%),and aphthous stomatitis and black pigmented tongue in 1 (0.83%) patients each. Hair abnormalities includedsparse scalp and body hairs in 43 (33%), 11 (8.4%), respectively and lusterless hair in 22 (16.9%) patients.Major nail abnormalities were half and half nails or Linday’s nails in 33(25.3%), longitudinal ridging in29(22.3%), leuconychia in 13(10%), onycholysis in 9(6.9%), Beau’s lines in 6(4.6%), koilonychias in4(3.07%), Mee’s lines in 1(0.76%) and Meuhrcke’s lines in 1(0.76%).Conclusions: Xerosis, pruritus, skin pallor/pigmentary changes, half and half nails, longitudinal ridging,discoloration, sparse hairs, coated tongue, xerostomia, macroglossia, and infections were the most commonmucocutaneous manifestations in the studied patients irrespective of hemodialysis status.

Lupus érythémateux et atteinte unguéale : étude rétrospective sur 14 patients

There are few studies focusing on ungual lesions in patients with lupus erythematosus (LE). The aim of this study is to describe our experience with ungual lesions in LE patients. A multicentric retrospective descriptive study was performed at the dermatology departments of the university hospitals in Strasbourg and at the Tenon hospital in Paris and involved reviewing the medical records and photographs of patients with ungual lesions. Fourteen patients were included: 12 (86%) were women with a median age of 38years (28-78years). All patients had cutaneous LE presenting as follows: 3isolated forms (21%), and associated with systemic LE (LES) for remaining 11patients (79%). The most frequent ungual or peri-ungual lesions were longitudinal ridging (12patients, 86%), onycholysis and cuticular alterations (8patients each, 57%), pterygium (7patients, 50%), melanonychia, onychoschizia and subungual hyperkeratosis (5patients with each, 36%). Among patients with pterygium and onychoschizia, respectively 6 (86%) and 5 (100%) presented the discoid LE subtype, while respectively 6 (86%) and 4 (80%) had multisystemic involvement. Ungual lesions do not appear specific and do not in themselves allow diagnosis of LE. They can in fact occur in other diseases such as connective tissue disorders. However, their diagnosis is important because certain of them, such as pterygium, can lead to severe ungual dystrophia, with functional consequences. In our study, pterygium and onychoschizia appeared to be associated with cutaneous discoid lupus erythematosus and multisystemic involvement. The coexistence of peri-ungual lesions related to cutaneous lupus erythematosus and/or multisystemic involvement does not out differentiation of lupus ungual lesions and post-inflammatory lesions.

Guitar pick as a nail prosthesis for progressive nail lichen planus

Nail lichen planus is an inflammatory disorder of the nails that may have significant impact on activities of daily living. Early in the disease course, longitudinal ridging and mild nail plate splitting may be aesthetic concerns. However, progressive disease may have much greater consequences (Fig 1).1 Dorsal pterygium, indicating irreversible damage to the nail matrix, manifests as a V-shaped scar extending from the proximal nailfold in place of the nail plate. Eventually, anonychia, or permanent nail loss, may occur.

Nail disorders in skin of color: Approach to onychoscopic diagnosis

Onychoscopy provides a better understanding of nail lesions in terms of diagnosis, monitoring of progression and response to treatment. Author have put forward a simplified way to approach to a nail lesion by onychoscopy. Onychoscopy of pigmentary, inflammatory, infections, neoplastic and connective tissue diseases affecting the individual of skin of color are described to construct a basic outline for onychoscopic approach to a nail lesion. Onychoscopy shows homogenous dark band in longitudinal melanocytic nevus (LMN), irregular black pigment with irregular longitudinal lines in melanoma, multi-colored pigmented patches in fungal melanonychia, purplish-black in subungual hematoma, transverse bands in the under surface of plate in true leukonychia, whitish- yellow patches in pseudoleukonychia. In psoriasis, irregular pits, salmon spots are seen whereas in lichen planus onychorrhexis, whitish linear splits and pterygium are observed. Eczema shows pits with lusterless surface. In Darier's disease, characteristic alternate white and red bands are present. Lichen striatus shows longitudinal erythematous bands and ridging. Red dots with white halos are characteristics in warts. Onychomycosis shows 'aurora borealis' pattern and white opaque and friable spots. Bowen's disease shows white scales with red dots. 'Woodworm appearance' and keratotic mass are seen in onychomatricoma and respectively. Squamous cell carcinoma reveals destruction of nail plate and glomus tumor demonstrates pinkish blush. In connective tissue diseases, characteristic changes are present nail fold capillaries. Onychoscopy assists in the analysis and differentiation of many dermatoses which affect nail unit with similar clinical manifestations.

Median canaliform dystrophy of thumb and great toe nails in an 8 years old boy

Median canaliform dystrophy is a rare nail disorder characterized by midline longitudinal ridging or splitting with canal formation in the nail plate of one or both the nails of the thumbs. It is an acquired condition that mimicks habit-tic deformity, resulting in a temporary defect in the nail matrix and cuticle. Treatment is often prolonged and unsatisfactory. Some clinicians have used topical tacrolimus (0.1%) ointment and tazarotene (0.05%) ointment successfully. We report the case of an 8-year-old boy presenting with median canaliform dystrophy of Heller affecting nails of both the thumbs and great toes, respectively.