10.5826/dpc.1303a184
text/xml
2160-9381
3010
en
Alise Balcere
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
onychoscopy
Median Nail Canaliform Dystrophy in Association With Retinoid Therapy
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-07-31
2022-11-21
2023-07-31
2023-08-24
e2023184
Dermatol Pract Concept
Alise Balcere
2023/07/31
10.5826/dpc.1303a184
e2023184
Department of Dermatology and Venereology, Riga Stradiņš University, Riga, Latvia
2160-9381
onychoscopy
en
e2023184
Beckenbach L, Baron JM, Merk HF, Löffler H, Amann PM. Retinoid treatment of skin diseases. Eur J Dermatol. 2015;25(5):384-391. DOI: 10.1684/ejd.2015.2544. PMID: 26069148.
Median Nail Canaliform Dystrophy in Association With Retinoid Therapy
https://dpcj.org/index.php/dpc/article/download/3010/2232
                     Median Nail Canaliform Dystrophy
                    in Association with Retinoid Therapy
                                          Laura Agnese Pauliņa1, Alise Balcere2


1 Faculty of Medicine, Riga Stradiņš University, Riga, Latvia
2 Department of Dermatology and Venereology, Riga Stradiņš University, Riga, Latvia



Key words: Drug-induced nail changes, onychopathy, nail plate splitting, onychoscopy.
Citation: Pauliņa LA, Balcere A. Median Nail Canaliform Dystrophy in Association With Retinoid Therapy. Dermatol Pract Concept.
2023;13(3):e2023184. DOI: https://doi.org/10.5826/dpc.1303a184
Accepted: February 8, 2023; Published: July 2023
Copyright: ©2023 Pauliņa et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Laura Agnese Pauliņa, Faculty of Medicine, Riga Stradiņš University, LV-1007 Riga, Latvia.
E-mail address: paulinalaura@inbox.lv




Introduction                                                             of oral isotretinoin therapy. Doses of 20 mg and 30 mg had
                                                                         been used alternately.
Median nail canaliform dystrophy (MNCD) is a rare nail                        Onychoscopy of the lesions showed median longitudinal
disorder. Clinically MNCD is characterized by longitudinal               splitting across midline of both thumbs with central trans-
midline nail plate splitting with canal formation and later-             versal furrows and splits resembling a fir-tree pattern. Clear
ally extending ridges that altogether resembles an inverted              canal formation was observed only on the right thumb. On
fir-tree shape. This condition most commonly affects one or              both nails lunula appeared enlarged (Figure 1B). No sur-
both thumbs [1]. Similar nail changes, though typically with-            rounding erythema or inflammation was observed. The pa-
out canal formation, could be also seen due to chronic nail              tient denied having a recent nail trauma or having a habit of
trauma, such as habitual nail picking, which is an important             biting or picking nails. According to these clinical findings, a
and common differential diagnosis when nail changes across               diagnosis of MNCD was made.
midline occur [2]. With this case report we want to improve                   As MNCD has been previously associated with retinoid
awareness of MNCD after isotretinoin use and inform of our               use, isotretinoin cancelation was proposed [3]. However, our
approach and results for managing MNCD.                                  patient was willing to continue the therapy with isotretinoin
                                                                         as she considered the experienced acne improvement prior

Case Presentation                                                        to nail changes. Therefore, a lowered dosage of isotretinoin
                                                                         to 10 mg per day and additional topical tacrolimus ointment
A 21-year-old woman presented to a dermatologist with                    for the nails was prescribed.
complains of painless lesions on both thumbs (Figure 1A)                      The follow-up visit was scheduled after two months, when
that had appeared approximately four months after initiation             the patient admitted that the prescribed topical tacrolimus




Research Letter | Dermatol Pract Concept. 2023;13(3):e2023184                                                                          1
    Figure 1. (A) Median nail canaliform dystrophy on both thumbs after 4 months of isotretinoin therapy. (B) Onychoscopy of the thumbs
    with better visualization of typical fir-tree shape changes across the midline of the nail plate and distinctive canal formation on one of
    the thumbs; enlarged lunula—4 months of isotretinoin therapy. (C) Outgrowth of healthy nails after 2 months of lowered isotretinoin
    therapy dosage to 10 mg per day. (D) Onychoscopic view 2 months after lowering isotretinoin dose.



ointment had not been applied and only 10 mg isotreti-                     References
noin once daily was taken. Nevertheless, at the follow-up
a healthy nail regrowth as well as maintained good acne                     1. Hoy NY, Leung AK, Metelitsa AI, Adams S. New concepts in me-
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                                                                               disease nail pathology. ISRN Dermatol. 2012;2012:680163.
(Figure 1, C and D).
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                                                                            2. Khodaee M, Kelley N, Newman S. Median nail dystrophy.
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Retinoids, having an anti-proliferative effect on cells, are
                                                                            3. Winther AH, Bygum A. Can median nail dystrophy be an ad-
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                                                                               verse effect of alitretinoin treatment? Acta Derm Venereol.
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Diagnosis of this condition is made clinically, based on its                   24691846.
typical fir-tree shape nail changes. The treatment of MNCD                  4. Beckenbach L, Baron JM, Merk HF, Löffler H, Amann PM. Ret-
is still not well established although most commonly topical                   inoid treatment of skin diseases. Eur J Dermatol. 2015;25(5):
                                                                               384-391. DOI: 10.1684/ejd.2015.2544. PMID: 26069148.
0.1% tacrolimus ointment and retinoid drug cancellation
have been proposed [1]. Our case adds that it is possible to
regain healthy nails by only lowering the dosage of retinoid
drug. No topical treatment for nails in our case was used.




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