HPI: The patient is an 18 year-old college student who has had alopecia areata for the past 2 years. He is well otherwise and has had no other problems until a number of months ago when he developed a nail dystrophy. He takes no medications by mouth. There is no family history of alopecia or autoimmune problems. Treatment to date for alopecia has been intralesional triamcinlone with regrowth, however, new areas continue to evolve.
O/E: There are 6 - 7 alopecic areas measuring from 2 to 6 cm in diameter widely scattered over the scalp. He has some areas of alopepcia on his abdomen.
19 of his nails are dystrophic. They are lusterless and many are greyish white in color, rough and friable. One of his toenails appears normal
Lab: All studies have been normal. Records of these have been requested.
Diagnosis: Alopecia areata and trachyonychia (aka 20 Nail Dystrophy)
Discussion and Questions: The patient has read about immunotherapy with DNCB and related chemicals. Has anyone treated a patient with this modality who experienced long-lasting remission? Do you know of good treatments for his nail dystrophy?
Alopecia universalis with twenty-nail dystrophy (trachyonychia).
Department of Dermatology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain. email@example.com Free Full Text