Onychodystrophy is commonly associated with alopecia areata (AA), with a prevalence ranging from 7%-66%. Either some or all of the nails may be affected. If all nails are affected, it is commonly referred to as twenty-nail dystrophy. The most common nail abnormalities are pitting and trachyonychia, but longitudinal ridging, onycholysis, red spotted lunulae, and onychomadesis may also be seen.
Patients with more severe AA are more likely to have nail changes. Nail changes may precede, follow, or coincide with the onset of hair loss.
In children, pitting, trachyonychia, and onychomadesis are the most common nail changes. Spotted lunulae are only seen in conjunction with pitting in children.
Alopecia areata - Nail and Distal Digit
See also in: Overview,External and Internal Eye,Hair and ScalpAlerts and Notices
Important News & Links
Synopsis
Codes
ICD10CM:
L63.9 – Alopecia areata, unspecified
SNOMEDCT:
68225006 – Alopecia areata
L63.9 – Alopecia areata, unspecified
SNOMEDCT:
68225006 – Alopecia areata
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Psoriasis – Nail pits in AA tend to be more regular and shallower compared with those of psoriasis.
- Lichen planus
- Onychomycosis
- Trauma
- Atopic or contact dermatitis of the nail folds
- Parakeratosis pustulosa
- Artificial nail damage
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:04/10/2017
Last Updated:05/31/2017
Last Updated:05/31/2017
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Alopecia areata - Nail and Distal Digit
See also in: Overview,External and Internal Eye,Hair and Scalp