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.
ICD10CM: L63.9 – Alopecia areata, unspecified
SNOMEDCT: 68225006 – Alopecia areata
Differential Diagnosis & Pitfalls
Psoriasis – Nail pits in AA tend to be more regular and shallower compared with those of psoriasis.
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.