National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Twenty-nail dystrophy

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A dermatologist recently advised that I have twenty-nail dystrophy. However, when I read about this, it is described as a childhood disorder.  Only as an adult have my nails become brittle, with ridges vertical and horizontal.  This has even affected my toenails.  Also, I am losing a lot of hair.  What causes twenty-nail dystrophy?

The following information may help to address your question:


Can twenty-nail dystrophy affect adults?

Although the symptoms of twenty-nail dystrophy usually begin in childhood, adults can also be affected by this condition.[1]  One article in the medical literature describes a woman who first showed symptoms of this condition at age 21.[2]  Another article describes an individual who was 63 when he first developed symptoms in his fingernails, but his toenails were not affected.  He was diagnosed with tachyonychia, and twenty-nail dystrophy is thought to be a type of tachyonychia.[3]
Last updated: 7/4/2012

What causes twenty-nail dystrophy?

The cause of twenty-nail dystrophy is unknown. In some cases, twenty-nail dystrophy has been diagnosed in people who also have another condition such as alopecia areata, or psoriasis.[4] There are a few reported cases where several members of the same family have been affected by this condition, which suggests that there may be a genetic cause.[5]
Last updated: 10/2/2017

Can twenty-nail dystrophy cause hair loss?

There is a recognized association between hair loss and twenty-nail dystrophy, but it is not known if one condition causes the other.  Individuals with twenty-nail dystrophy often also have hair loss, though the extent of hair loss varies from mild to severe.  In severe cases of hair loss, the individual may have a condition called alopecia areata.[6]
Last updated: 7/4/2012

We hope this information is helpful. We strongly recommend you discuss this information with your doctor. If you still have questions, please contact us.

Warm regards,
GARD Information Specialist

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  1. Sehgal VN. Twenty nail dystrophy trachyonychia: an overview. Journal of Dermatology. 2007; 34:361-366. http://www.ncbi.nlm.nih.gov/pubmed/17535400. Accessed 7/4/2012.
  2. Ohta Y, Katsuoka K. A case report of twenty-nail dystrophy. Journal of Dermatology. 1997; 24:60-62. http://www.ncbi.nlm.nih.gov/pubmed/9046745. Accessed 7/4/2012.
  3. Sakata S, Howard A, Tosti A, Sinclair R. Follow up of 12 patients with trachyonychia. Australasian Journal of Dermatology. 2006; 47:166-168. http://www.ncbi.nlm.nih.gov/pubmed/16866995. Accessed 7/4/2012.
  4. Jacobsen AA, Tosti A. Trachyonychia and Twenty-Nail Dystrophy: A Comprehensive Review and Discussion of Diagnostic Accuracy. Skin Appendage Disord. September 2016; 2(1-2):7-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096243/.
  5. Nail Disorder, Nonsyndromic Congenital 1. Online Mendelian Inheritance in Man (OMIM). August 11, 2011; https://www.omim.org/entry/161050.
  6. Gordon KA, Vega JM, Tosti A. Trachyonychia: a comprehensive review. Indian Journal of Dermatology, Venereology, and Leprology. 2011; 77:640-645. http://www.ncbi.nlm.nih.gov/pubmed/22016269. Accessed 7/4/2012.