Scotch-plaid nails

Prateek Nayak; Gopikrishnan Anjaneyan

doi:10.25259/JONS_1_2025

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Onychoterminology (Typical Clinical or Onychoscopic Sign)

2 (

1

); 60-60

doi:

10.25259/JONS_1_2025

Scotch-plaid nails

Prateek Nayak¹_MD., Gopikrishnan Anjaneyan^2,_{MD, DNB}

1Department of Dermatology, Venereology, Leprology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India

2Department of Dermatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

*Corresponding author: Gopikrishnan Anjaneyan, Department of Dermatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India. drgopikrishnana@gmail.com

Received: 2025-01-07, Accepted: 2025-04-17, Published: 2025-06-11

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Nayak P, Anjaneyan G. Scotch-plaid nails. J Onychol Nail Surg. 2025;2:60. doi: 10.25259/JONS_1_2025

CASE DETAILS

A 34-year-old male with alopecia areata (ophiasis pattern) presented with abnormal indentations on all 10 fingernails. Physical examination revealed regular and shallow pits, arranged both horizontally and vertically, creating a distinct grid-like pattern, similar to a scotch plaid [Figure 1a and b].

(a and b) Multiple horizontally and vertically arranged nail pits resembling a scotch-plaid pattern.

DESCRIPTION

Scotch-plaid nails are a rare but distinctive feature of alopecia areata (AA), characterised by fine and geometric crisscross pitting resembling Scottish tartan fabric. Nail involvement affects 7–84% of AA patients, with pitting, trachyonychia and red lunulae being most prevalent often correlating with disease severity and therapeutic resistance. Histopathologically, these pits are lined by parakeratotic cells on the dorsal nail plate surface, reflecting disrupted keratinisation from lymphocytic infiltration. While topical corticosteroids and intralesional triamcinolone show limited efficacy, emerging evidence highlights Janus kinase-signal transducer and activator of transcription inhibitors (tofacitinib and baricitinib) as dual-action therapeutics, demonstrating concurrent hair regrowth and nail normalisation in case reports.

Authors’ contributions:

PN: Conceptualization, data curation, writing - original draft, writing - review & editing. GA: Conceptualization, writing - review & editing, supervision.

Ethical approval:

Institutional Review Board approval is not required.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship: Nil.