Chevron nail and atopic dermatitis: An incidental association

Subrata Malakar, Rita Shah Malakar

 Duncan Gleneagles Clinic and Research Centre, India

Correspondence Address:
Subrata Malakar
P - 158, CIT scheme, VIM, Calcutta - 700 054
India

Introduction

Chevron nail is nail plate surface pattern described recently.[1] V-shaped bar or bars are present on the nail plate; thereby, the name chevron nail is proposed for this abnormality. We describe 3 patients with chevron nail; one of them has been suffering from atopic dermatitis (AD) and family history of atopy was present in the other 2 patients.

Case 1

A 21 - year -old female had atopic dermatitis since last 4 years. On examination, her nail plate of left index and middle, and right index, middle and little fingers showed a distinct pattern. The ridges were logitudinal but not parallet to each other, rather they seemed to converge at a distal point. Thus an arbitrary multiple V- shapes of ridges were formed. A diagnosis of chevron nail was made.

Case 2

A 13 - year - old girl had vitiligo since past 5 years. On examination, chevron nail pattern was noticed on her right middle and index fingers. Excepting a few white spots on the nails of right index finger and left thumb, no other abnormality was found on her nails. Her mother had bronchial asthma and her elder brother had chronic idiopathic urticaria.

Case 3

An 18 - year- old male presented with fixed drug eruption on his glans penis. The offending drug, on history, was found to be tetracycline. His nail pattern, on examination, showed chevron nail. The pattern was observed on right index, middle and ring fingers. His father had bronchial asthma.

Discussion

Chevron nail was first described by Zaiac et al.[1] The nail plate showed a distinct pattern and was characterized by V- shaped bar or bars. Arising in the nail from under the proximal nail fold, there were uniform symmetric longitudinal ridges extending distally. These ridges were not parallel and seemed to converge towards a midpoint distally-this was the original description of chevron nail by Zaiac et al. The chevron nail affected all the 10 nails in all the 5 patients reported by them. None of our patients had chevron nails in all the 10 nails. Rather we observed an association of atopy. Till now, no specific pattern of nail change (s) had been associated with AD. The nails in AD always showed nonspecific changes. Ridging, the specific arrangement of which formed V - shape on nail in chevron nail, is normal in ageing people and at present its significance remains unclear. As the basics of ridging were poorly understood and the ridges could be present on the nail plate, at least theoretically, in any arrangement e.g., longitudinal, slanting (it might lead to chevron nail) or both longitudinal and slanting in the same nail plate, it would be very difficult to conclude or comment anything on the ridges or chevron nail. Though all of our patients showed an association with atopy, it would be very premature to associate both atopy and chevron nail when Zaiac et al, the original observers of chevron nail, commented "long - term observation of these patients will tell us if this is a permanent or transient abnormality."

1.	Zaiac MN, Glick BP Zaias N. Chevron nail. J Am Acad Dermatol 1998;38:773. [Google Scholar]