Median Nail Dystrophy: Causes, Symptoms, Treatment, Diagnosis

Median nail dystrophy is marked by the abnormal appearance of a split in the mid line of the nail, especially the thumb nail, in longitudinal direction towards the edge of the nail. Median nail dystrophy results from a defect in the nail’s matrix. This rare nail abnormality was first found by Heller in 1928 and so is also known as median canaliform dystrophy of Heller. Median nail dystrophy occurs in both males and females.

The exact cause of Median nail dystrophy is still uncertain. However, it is suspected that temporary defect in the nail’s matrix median triggers median nail dystrophy. This disruption can occur because of factors like infection in the nail or nail bed, or a self inflicted nail injury, and interferes in the normal formation of the nail. Even habitual nail picking, frequent manicure and intake of medicines used to treat eczema and acne, can give rise to Median nail dystrophy. Using the thumb nail while playing guitar and even frequent use of mobile phones can cause median nail dystrophy.

Median nail dystrophy is characterized by a peculiar “inverted evergreen tree” pattern with a midline split on the nail. This canal-like split starts from the cuticle and extends till the tip of the nail. There are parallel lines in the centre which give it the look of an inverted Christmas tree or fir tree. Median nail dystrophy is usually symmetrical and frequently affects the thumbs, although other fingers or toes can be involved too.

The inverted fir tree appearance, longitudinal ridges and depression in the central region of the nail are the distinguishing features which help to identify median nail dystrophy. Clinical presentation can help diagnose median nail dystrophy accurately. However, possibility of certain other medical condition like mucus cyst of finger, Raynaud disease, habit-tic deformity, nail patella syndrome, etc, must be ruled out before zeroing down on nail dystrophy.

Median nail dystrophy usually does not require any treatment as it heals on its own over time. In case the condition persists and does not heal on its own, then the individual would need to consult their healthcare provider and undergo the appropriate medical therapy.

Median nail dystrophy is a reversible condition and can be cured with proper treatment. However, in certain cases this condition becomes difficult to treat with a single therapy. When caused by physical injury, Median nail dystrophy can be resolved by applying certain prescription topical ointments. Intake of multivitamins can further help in strengthening the matrix.

If median nail dystrophy is caused by the use of retinoids, i.e. the acne treating medicine, then this medication should be stopped immediately. Discontinuation of the medicine will helps to cure this nail condition. However, if the healing process does not begin even months after the discontinuation, patients are advised to keep medical help right away.

To prevent median nail dystrophy, one must avoid picking their nails and stop engaging in activities that can cause nail trauma. The nail should not be cut frequently to shorten its length. To avoid nail damage, one should not buff their nails too. Patients must clip their nail regularly to remove the ridges which hurt the nail.

There are several causes which are believed to trigger Median nail dystrophy. Trauma on the nail is implicated as one of the main causes. If the accurate cause is known, dystrophy can be cured simply by discontinuing the activity which leads to the nail trauma. However, if the problem is taking longer than normal to show signs of improvement, medical intervention may be needed to treat this nail issue. No therapy is consistently successful in treating median nail dystrophy as effectiveness of treatments depends on individual cases. One may get respite from median nail dystrophy for months or years but the chance of reoccurrence always exists.