Down Syndrome, Alopecia Universalis, and Trachyonychia

A 16‐year‐old boy with Down syndrome and alopecia universalis had dystrophy of all nalis. A presumptive diagnosis of tinea ungulum, common in persons with Down syndrome, had been made nine years earlier. Despite antifungal therapy, the condition of the nails worsened. We were unable to detect fungi, and believe that his nail changes are most consistent with alopecia‐associated trachyonychia (formerly 20‐nail dystrophy), a condition not previously reported in persons with Down syndrome. The opinions and assertions contained herein art the views of the authors and are not to be considered as reflecting the views of the Department of the Army or the Department of Defense.