Median canaliform dystrophy of Heller

Median Canaliform Dystrophy of Heller in a Carpet Weaver: A New Risk Factor? - A Case Report

Introduction

Median canaliform dystrophy of Heller (MCDH) is a rare nail disorder that typically affects the thumbnails and is characterized by transverse ridges radiating from a paramedian canal or split in the nail plate, bearing resemblance to a fir tree.

Case Report

We report here a case of a 60-year-old woman of rural origin, a carpet weaver, with no specific medical history. She was referred due to nail dystrophy on her thumbs that had been progressing over the last 10 years. Clinical examination revealed the presence of a midline splitting with a fir tree-like appearance of ridges angled backwards and normal cuticle. These lesions were symmetrically present on both thumbnails and the big toe nail. Based on this presentation, a diagnosis of Heller's canaliform dystrophy was established.

Conclusion

Although the pathophysiology of MCDH remains unclear, proposed mechanisms include keratinocyte adhesion abnormalities, genetic predisposition, and inflammation within the nail matrix. Risk factors encompass medications like oral retinoids and self-inflicted trauma, as seen in repetitive cuticle manipulation. In this case, the patient's nail dystrophy resulted from chronic local microtrauma due to her carpet weaving occupation, suggesting certain manual professions may contribute to MCDH development.

Median Nail Dystrophy Involving the Thumb Nail

Median canaliform dystrophy of Heller is a rare entity characterized by a midline or a paramedian ridge or split and canal formation in nail plate of one or both the thumb nails. It is an acquired condition resulting from a temporary defect in the matrix that interferes with nail formation. Habitual picking of the nail base may be responsible for some cases. Histopathology classically shows parakeratosis, accumulation of melanin within and between the nail bed keratinocytes. Treatment of median nail dystrophy includes injectable triamcinalone acetonide, topical 0.1% tacrolimus, and tazarotene 0.05%, which is many a times challenging for a dermatologist. Psychiatric opinion should be taken when associated with the depressive, obsessive-compulsive, or impulse-control disorder. We report a case of 19-year-old male diagnosed as median nail dystrophy.

Median Canaliform Dystrophy of Heller occurring on thumb and great toe nails

Median Canaliform Dystrophy of Heller is a rare but morphologically striking habit tic deformity of thumb nails characterized by midline longitudinal furrow with multiple transverse parallel lines. The proposed etiopathogenesis is repetitive trauma to the nail plate and cuticle, however some case reports have suggested familial occurrence and use of oral retinoids in its causation. Treatment is often prolonged and unsatisfactory, though some topical agents have been used successfully. We report a case of a young male patient presenting with Median Dystrophy of Heller affecting both Great thumb and toe nails simultaneously.