Twenty-Nail Dystrophy: A Variant of Lichen Planus

Twenty-nail dystrophy of childhood was described by Hazelrigg and colleagues1as a distinct clinical entity. However, no nail biopsies were performed by these authors in their study, and to our knowledge, there is not any published instance of it being done. In the section for diagnosis and treatment of nail diseases at our institution, we were aware of having seen six cases that very closely matched those described by Hazelrigg et al.1Our clinical diagnosis in all of these cases was lichen planus. We performed a nail biopsy on one such patient. Incidentally, one of our subjects was an adult; this finding has been reported elsewhere.2,3 Report of a Case A 7-year-old boy had abnormalities of all 20 nails. The changes consisted of onychorrhexis with distal splitting (Fig 1). The nails exhibited increased fragility and were thinner and less transparent than normal. No abnormal findings were noted on