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Genetic and Rare Diseases Information Center (GARD)

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Twenty-nail dystrophy

Other Names for this Disease
  • Onychodystrophy totalis, isolated
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Your Question

A dermatologist recently advised that I have twenty-nail dystrophy. However, when I read about this, it is described as a childhood disorder.  Only as an adult have my nails become brittle, with ridges vertical and horizontal.  This has even affected my toenails.  Also, I am losing a lot of hair.  What causes twenty-nail dystrophy?

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

Can twenty-nail dystrophy affect adults?

Although the symptoms of twenty-nail dystrophy usually begin in childhood, adults can also be affected by this condition.[1]  One article in the medical literature describes a woman who first showed symptoms of this condition at age 21.[2]  Another article describes an individual who was 63 when he first developed symptoms in his fingernails, but his toenails were not affected.  He was diagnosed with tachyonychia, and twenty-nail dystrophy is thought to be a type of tachyonychia.[3]
Last updated: 7/4/2012

What causes twenty-nail dystrophy?

The exact cause of twenty-nail dystrophy is unknown.  Most cases occur by chance without any other symptoms.  In some cases, twenty-nail dystrophy has been diagnosed in individuals who also have another skin condition such as alopecia areata, eczema, or psoriasis; this has led some physicians to question whether the skin condition causes twenty-nail dystrophy in those individuals.[3][4]  And in a few rare cases where several members of the same family have been affected by this condition, physicians suspect there may be a genetic cause.[1]
Last updated: 7/4/2012

Can twenty-nail dystrophy cause hair loss?

There is a recognized association between hair loss and twenty-nail dystrophy, but it is not known if one condition causes the other.  Individuals with twenty-nail dystrophy often also have hair loss, though the extent of hair loss varies from mild to severe.  In severe cases of hair loss, the individual may have a condition called alopecia areata.[4]
Last updated: 7/4/2012