Abstract
TO THE EDITOR. —We read with great interest in the August 1990 issue of the Archives the article by Jerasutus et al.1 on the pathological features of 20-nail dystrophy. This nail symptom, which has also been referred to as trachyonychia, can either be a sign of a definite disease, such as alopecia areata, lichen planus, or psoriasis or be apparently idiopathic.1,2 In the last few years we have detected spongiotic inflammation of the nail apparatus in the nail biopsy specimens from 13 patients affected by severe trachyonychia involving all 20 nails.Eleven patients were affected or had been affected by alopecia areata, whereas two patients had a nail dystrophy that was apparently idiopathic. Similar pathological changes were present in all the biopsy specimens. A mild to moderately dense lymphocytic infiltrate was detected in the superficial dermis of the proximal nail fold, nail matrix, nail bed, and hyponychium. Exocytosis
