Nail Deformity in the Shape of a Christmas Tree

I thought this photo was appropriate for the upcoming holidays! I saw a patient today who had an irregualar thumbnail in the shape of a Christmas tree. After further questioning, the patient admitted she routinely picks at her nail and cuticle. This condition is called Median nail dystrophy, or Median canaliform dystrophy of Heller.

Median nail dystrophy is a split in the mid-line of the nail starting at the cuticle. The condition usually affects the thumb, but can affect any finger or toenail. It results from a temporary defect that interferes with nail formation. The most common cause of median nail dystrophy is nail picking, usually by the nail of the index finger on the same hand. The condition is more often during periods of stress. Other causes include and repetitive trauma such as overuse of cellphone and guitar playing. This dystrophy can be similar to a habit-tic deformity, which means that it is caused by repeated back-and-forth picking of the nail. The condition is marked by an “inverted evergreen tree” pattern with a mid-line split on the thumbnail. This canal-like split extend from the cuticle to the tip of the nail, with parallel lines in the center, giving the appearance of an inverted fir tree or Christmas tree. To treat the nail, you must stop picking your nail and stop the activities that may contribute to your median nail dystrophy. The condition usually improves over time, so no treatment is necessary.

Dr. Cindy N. Berthelot, M.D. is a board certified dermatologist treating patients in the greater Houston community, including Clear Lake, League City, Friendswood, Pasadena, Deer Park, Dickinson, Pearland, Alvin, Seabrook, Kemah, Webster, Galveston, Texas City, La Marque, and Santa Fe, Texas. To make an appointment with Dr. Berthelot, please contact us at 281.480.7272.