Treatment of median canaliform nail dystrophy with topical 0.1% tacrolimus ointment

Abstract

Median canaliform nail dystrophy (MCND) is an uncommon and idiopathic dystrophic change, typically showing a longitudinal groove or split involving one or both thumbnails. Various agents have been tried to treat the disease, but it is often resistant to many topical treatments. We report a patient with median nail dystrophy who was treated with topical tacrolimus ointment with excellent clinical improvement. A 19-year-old man presented with abnormality of both thumbnails that had persisted for several years. He did not complain of any symptoms. On nail examination (Fig. 1), multiple transverse grooves of both thumbnails were observed, which had developed from the proximal ends and gradually extended towards the distal ends, aligned at the middle of the nail plates. The lunulae of both thumbnails seemed to be a little larger than others. In addition, the surfaces of nail plates were rough, and callosity was found around the periungual area with no evidence of paronychia.