Understanding rough nails (trachyonychia)

Rough nails are associated with a handful of dermatological conditions, and thus diagnosing the cause requires some good investigative skills on the part of your dermatologist.

The first thing you may have been treated for is a fungal nail infection, but antifungals may not have resolved the issue. This brings on the next phase of investigations, which might include looking into any history of lichen planus, psoriasis or alopecia areata.

Rough nails have two variations: opaque trachyonychia (ridges that run longways down the rough, sandpapery nail) and shiny trachyonychia (shiny pitted nail in lengthways and sideways lines).

Trachyonychia is usually associated with another dermatological condition, so expect some investigations. Lichen planus, psoriasis and alopecia areata are the main suspects, but these conditions typically appear elsewhere on the body in other forms, making diagnosis a bit easier. Trachyonychia can be difficult to figure out if only the nails are affected, so a test for fungus may be taken if it hasn’t already.

Other conditions that trachyonychia has been associated with:

• Eczema
• Graft-vs-host disease
• Dry, scaly, thickened skin conditions (ichthyosis vulgaris)
• Immunoglobulin A deficiency
• A genetic disorder (incontinentia pigmenti)
• ‘Spoon nails’ (koilonychia)
• Skin blistering disease (pemphigus)
• Cirrhosis of the liver
• Trauma to the skin
• Vitiligo
• Long-term pain syndrome (reflex sympathetic dystrophy)

The cause of trachyonychia is inflammation, with the shiny, pitted version seeing only intermittent inflammation.

Treatment of trachyonychia

Rough nails do not scar and treatment is not necessary, since a lot of the time trachyonychia will resolve by itself. No intervention is necessary, though steroids and some topical creams may help. In shiny trachyonychia, nail polish can be used if desired. Your dermatologist will be possibly treating you for your other conditions, in which case the nail problems will disappear as treatment progresses for any other underlying conditions.

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