Twenty-Nail Dystrophy in Adults

To the Editor.— Twenty-nail dystrophy as described by Hazelrigg et al 1 is a condition seen in childhood. This idiopathic dystrophy, not accompanied by any other disease, is characterized by the uniform and simultaneous involvement of all 20 nails with excess longitudinal ridging and loss of luster. Recently, we saw a 19-year-old woman who, at the age of 17 years, had noticed that all her nails had become ridged and dull. About one year before the onset of the nail changes, the patient had had eczema of the hands, probably on a contact basis, for a short period. The nails were not involved. There was no family history of skin or nail disease. Examination indicated that all 20 nails were thin, opalescent, and rough because of excessive longitudinal ridging. The nail edges were split, and the nails of the feet were yellow. There was no evidence of a mycotic infection,