DOI: 10.36347/sjmcr.2015.v03i11.034

Pages: 1120-1123

Twenty-nail dystrophy or trachyonychia is widespread dystrophy involving all twenty nails, can be idiopathic or is caused by many conditions such as lichen planus, eczema, psoriasis and alopecia areata. Onychomycosis though can lead to total dystrophic onychomycosis, but is not considered as a cause of twenty-nail dystrophy. A 50 years old male presented in dermatology outpatient department with thickening and yellowish discoloration of all twenty nails with thickening of palms and soles for 15 years. Examination revealed thickened nail plates with yellowish discoloration in all twenty nails, palmoplantar keratoderma with mild scaling and multiple, scaly, erythematous plaques over chest, abdomen, dorsa of feet, forearms, groins and buttocks. All routine investigations including viral markers were within normal limits. KOH examination of subungual hyperkeratotic material and skin scrapings showed presence of fungal hyphae. Fungal culture yielded T.mentagrophyte. PAS staining of histopathology specimen proved palmoplantar keratoderma due to dermatophytes as fungal hyphae were seen. This case is being reported for rare presentation of twenty-nail dystrophy due to dermatophytosis.