Indian Journal of Dermatology
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Year : 2012  |  Volume : 57  |  Issue : 4  |  Page : 329
Twenty nail dystrophy in association with zosteriform lichen planus

Department of Dermatology, Venereology and Leprosy, Katihar Medical College, Katihar, Bihar, India

Date of Web Publication29-Jun-2012

Correspondence Address:
Satyaki Ganguly
Department of Dermatology, Venereology and Leprosy, Katihar Medical College, Katihar, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.97689

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How to cite this article:
Ganguly S, Jaykar KC. Twenty nail dystrophy in association with zosteriform lichen planus. Indian J Dermatol 2012;57:329

How to cite this URL:
Ganguly S, Jaykar KC. Twenty nail dystrophy in association with zosteriform lichen planus. Indian J Dermatol [serial online] 2012 [cited 2022 Dec 3];57:329. Available from:


A 30-year-old male presented with roughness, ridging, flattening, and opacity of all the fingernails and six of the toenails since the last two years [Figure 1]. In the beginning, these changes appeared only in two fingernails; then other nails became involved and the degree of involvement increased in severity. On detailed examination of the patient, multiple violaceous flat papules and plaques were found on the left side of his trunk in a dermatomal distribution [Figure 2]. Similar lesions were not found anywhere else in the body. Oral and genital mucosa were normal. According to him, these lesions appeared around 3 months back. Routine hematological and biochemical examinations were within normal limits. A skin biopsy done from one of the skin lesions showed basal cell degeneration, interface lymphocytic infiltrate, and melanin incontinence. Therefore a diagnosis of segmental or zosteriform lichen planus in association with 20-nail dystrophy was made [Figure 3]. The patient was started on systemic corticosteroids and antihistamines.
Figure 1: Finger and toe nail involvement

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Figure 2: Multiple violaceous papules and plaques in a dermatomal distribution

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Twenty-nail dystrophy is characterized by a spectrum of nail plate abnormalities that leads to nail roughness or trachyonychia. It can be idiopathic or may be associated with lichen planus, psoriasis, alopecia areata, ichthyosis vulgaris, eczema, vitiligo, primary biliary cirrhosis, IgA deficiency, and graft-versus-host disease. [1],[2] Twenty-nail dystrophy has congenital, familial, and acquired forms. All nails may or may not be involved. The nails show excessive longitudinal ridging and become rough, thin, and opaque, giving the appearance of sandpaper nails. Lichen planus can be linear as a result of Koebner's phenomenon or can appear as a band of lesions in a dermatomal or Blaschkoid distribution. [3] Lichen planus is a common cause of 20-nail dystrophy, but 20-nail dystrophy has not been described in association with zosteriform lichen planus, making this a rare case. Also, in this case lichen planus developed long after development of 20-nail dystrophy. So, prolonged follow-up of apparently idiopathic 20-nail dystrophy cases can reveal one of the proven etiologies.
Figure 3: Skin lesions with thin, rough, longitudinally ridged opaque nails

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   References Top

1.Horn RT Jr, Odom RM. Twenty-nail dystrophy of alopecia areata. Arch Dermatol 1980;116:573-4.   Back to cited text no. 1
2.Baran R, Dawber RP. The nail in childhood and old age. In: Baran R, Dawber RP, editors. Diseases of the nails and their management. Oxford: Blackwell Scientific Publications; 1984. p. 105-20.  Back to cited text no. 2
3.Vora SN, Mukhopadhyay A. Zosteriform lichen planus. Indian J Dermatol Venereol Leprol 1994;60:357-8.  Back to cited text no. 3
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  [Figure 1], [Figure 2], [Figure 3]


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