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LETTER TO THE EDITOR
Year : 2012  |  Volume : 3  |  Issue : 3  |  Page : 224-225  

Median canaliform dystrophy of Heller


Department of Skin and VD, Topiwala National Medical College and Bai Yamuna Laxman Charitable Hospital, Mumbai, Maharashtra, India

Date of Web Publication29-Sep-2012

Correspondence Address:
Chitra Nayak
OPD 14, Second Floor, OPD building, Nair Hospital, B.Y.L Ch. Hospital and Topiwala National Medical College, Dr. Anandrao Nair Road, Mumbai Central, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.101832

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How to cite this article:
Madke B, Gadkari R, Nayak C. Median canaliform dystrophy of Heller. Indian Dermatol Online J 2012;3:224-5

How to cite this URL:
Madke B, Gadkari R, Nayak C. Median canaliform dystrophy of Heller. Indian Dermatol Online J [serial online] 2012 [cited 2019 Jul 15];3:224-5. Available from: http://www.idoj.in/text.asp?2012/3/3/224/101832

Sir,

Median canaliform dystrophy of Heller is a rare entity characterized by a midline or a paramedian ridge or split and canal formation in the midline of the nail plate of one or both the thumb nails. [1] Intentional trauma in the form of pushing back of cuticle and proximal nail fold (habitual tic) is hypothesized in its pathogenesis. [2] A few cases of median canaliform dystrophy have been attributed to oral retinoid use. [3],[4] The majority of cases of median canaliform dystrophy are idiopathic, and the condition reverts to normal after a period of months to years. The treatment of median canaliform dystrophy is far from satisfactory; however, a few workers have used topical tacrolimus 0.1% ointment with significant improvement in nail plate appearance. [5]

A 25-year-old college student presented to the dermatology outpatient division with backwardly-angled ridges on her thumbnails resembling a fir tree and was concerned about the cosmetic appearance. We tried to elicit history of intentional pushing back of cuticular portion of the proximal nail fold, but she denied the same. The patient did not report any history of contact with known allergens and irritants. She did not have any family history of nail disorders. On examination, her right thumbnail showed paramedian longitudinal inverted fir tree-like dystrophy, while her left thumb showed similar changes that were masked by nail polish [Figure 1]. The rest of the fingernails and toenails were apparently normal. The median groove started under the proximal nail fold and gradually extended toward the distal nail edge. Nail plate and subungual scraping for fungal elements were negative on potassium hydroxide mount. She was diagnosed to have median canaliform dystrophy of Heller. She was prescribed topical tazarotene 0.05% ointment to be applied at bedtime and was asked to follow-up after 3 weeks.
Figure 1: Both the thumbnails showing inverted fir tree-like ridging

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Median canaliform dystrophy of Heller, also known as solenonychina, dystrophia unguis mediana canaliformis, and nevus striatus unguis, is a condition of the nail in which longitudinal splitting occurs. [6] The exact etiology of this intriguing condition is yet to be elucidated. However, subungual skin tumors, such as glomus tumors, [7] myxoid tumors, and other tumors have been described resulting in longitudinal grooving and lifting of the nail plate from the bed. [2] In 2005, Sweeney et al. have reported a familial clustering of cases of median nail dystrophy. [8] Self-inflicted nail trauma in the form of manipulation of the cuticular portion of nail fold has been implicated as one of the causes of median nail dystrophy. Typically, the condition is characterized by a split in the middle portion of nail plate, which resembles a fir tree with back angles of branches. In case of subungual tumors such as papilloma or glomus tumor, a tube-like structure (solenos) forms distal to it.

The management of such improperly understood nail disorders is quite challenging for a dermatologist. If a patient has an obsessive-compulsive or impulse-control disorder and suffers from habit tic, an opinion of a psychiatrist should be sought and appropriate psychotropic drugs such as fluoxetine, a serotonin reuptake inhibitor (SSRI), should be instituted before irreversible nail damage sets in. Topical immunomodulatory drugs such as tacrolimus gave good results in one patient after 4 months of once daily application. [5] However, the authors have not detailed the exact mechanism of action of topical tacrolimus in their patient. We started topical tazarotene ointment (a third generation retinoid) in our patient as it is known to normalize the process of keratinization. [9]

To summarize, median canaliform dystrophy belongs to a heterogeneous group of a rare nail conditions with far from satisfactory line of management. We report this case to highlight the fact that often in such cases, the history of 'habit tic' may not be acknowledged by the patient.

 
   References Top

1.Beck M, Wilkinson S. Disorders of nails: Medican canaliform dystrophy. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 7 th ed. Oxford: Blackwell Science; 2004. p. 54-5.  Back to cited text no. 1
    
2.Griego RD, Orengo IF, Scher RK. Median nail dystrophy and habit tic deformity: Are they different forms of the same disorder? Int J Dermatol 1995;34:799-800.  Back to cited text no. 2
    
3.Bottomley WW, Cunliffe WJ. Median nail dystrophy associated with isotretinoin therapy. Br J Dermatol 1992;127:447-8.  Back to cited text no. 3
    
4.Dharmagunawardena B, Charles-Holmes R. Median canaliform dystrophy following isotretinoin therapy. Br J Dermatol 1997;137:658- 9.  Back to cited text no. 4
    
5.Kim BY, Jin SP, Won CH, Cho S. Treatment of median canaliform nail dystrophy with topical 0.1% tacrolimus ointment. J Dermatol 2010;37:573-4.  Back to cited text no. 5
    
6.Wu CY, Chen GS, Lin HL. Median canaliform dystrophy of Heller with associated swan neck deformity. J Eur Acad Dermatol Venereol 2009;23:1102-3.  Back to cited text no. 6
    
7.Verma SB. Glomus tumor-induced longitudinal splitting of nail mimicking median canaliform dystrophy. Indian J Dermatol Venereol Leprol 2008;74:257-9.  Back to cited text no. 7
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8.Sweeney SA, Cohen PR, Schulze KE, Nelson BR. Familial median canaliform nail dystrophy. Cutis 2005;75:161-5.  Back to cited text no. 8
    
9.Berbis P. [Retinoids: Mechanisms of action]. Ann Dermatol Venereol 2010;137:97-103.  Back to cited text no. 9
    


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This article has been cited by
1 Median Canaliform Dystrophy of Heller occurring on thumb and great toe nails
Vikas Pathania
Medical Journal Armed Forces India. 2015;
[Pubmed] | [DOI]



 

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