A Clinical Study of 21 Cases of Washboard Nail

Chun, Ji Hoon; Kim, Jung Eun; Oh, Shin Taek; Park, Hyun Jeong; Cho, Baik Kee

Abstract

BACKGROUND
Washboard nail most commonly involves the thumbnail or great toenail. As its name implies, it resembles a washboard with a series of evenly spaced ridges across the nail. A central depression can be seen as well. This can develop as the result of repeated habitual trauma to the proximal nail fold by the other fingers or by biting the nailplate. Thus, it is also called habit tic deformity or traumatic nail dystrophy. Although it is known to be not uncommon, there have been no studies on this with a sufficient number of cases and long term follow up.
OBJECTIVE
This study was conducted to provide a better understanding of washboard nail and to estimate the outcome of it.
METHODS
We reviewed all the medical records and clinical photographs of 21 patients who had been diagnosed with washboard nail at our department between July 2000 and July 2009.
RESULTS
The male to female ratio was 1:1.3. The patients' ages varied from 6 to 68 years, with an average of 25.4 years. The mean duration at the first visit was 4.4 years. The most common involved site was both thumbnails. Predisposing factors were found in 42.9% of the patients, which included nail picking or onychophagia. The treatment options were primarily intralesional triamcinolone injection and topical steroid. If the patient had the habitual tic, we educated them to restrain it. The follow up periods varied from 1 to 32 months with a mean of 7.9 months. Among the 14 patients with adequate follow up, 50% of these patients showed clinical improvement.
CONCLUSION
This study demonstrated the clinical features of washboard nail. Physicians should closely observe the nail changes and long-term follow up is needed to determine the therapeutic response of patients with washboard nail.