Heller’s Median Nail Dystrophy

Heller – The first case of a paramedian ridge or split and canal formation in nail plate of one or both the thumbnails was recorded by Heller in 1928

Median – Middle, Center, Midpoint, etc.

Nail –  The hard, anatomical structure of bound cells protecting the distal phalanx, the nail plate

Dystrophy – Destruction of tissue 

Heller’s Median Nail Dystrophy (also known as “solenonychia”) is a rare entity characterized by a midline or a paramedian ridge in the nail plate of either thumb. It is usually an acquired condition resulting from a temporary defect in the nail matrix that interferes with nail formation. A single cause for HMND is not known but it usually occurs from:
-dyskeratinization (abnormal keratinization occurring prematurely within individual cells or groups of cells below the stratum granulosum), or
-a focal infection (a localized or general infection caused by the dissemination of microorganisms or toxic products from a focus of infection) somewhere between the proximal nail fold and the nail matrix, or
-self-inflicted trauma to the nail or the nail bed.

Put simply: A Heller’s Median Nail Dystrophy is a tear in the nail plate, first visible at the proximal nail fold that in time looks like an upside-down Christmas tree that starts out of view, possibly because of nail unit trauma or infection.

Heller’s Median Nail Dystrophy occurs in the thumbnail unit, often first on the dominant hand.

Recovery of a Heller’s Median Nail Dystrophy is tedious and long, and, although it is not proven that a Heller’s Median Nail Dystrophy is a condition that can be inherited, it is noted in the medical literature that, once it has occurred, recurrence is much more likely.

In past medical journals, it was sometimes confused with habit-tick nail plates that indeed do have median dystrophy. However, clinically this has been proven to be different in nature from HMND.

References:

• Hoy NY, Leung AK, Metelitsa AI, Adams S. New concepts in median nail dystrophy, onychomycosis, and hand, foot, and mouth disease nail pathology. ISRN Dermatol. 2012;2012:680163. doi:10.5402/2012/680163. Journal
• Kota R, Pilani A, Nair PA. Median nail dystrophy involving the thumb nail. Indian J Dermatol. 2016;61(1):120. doi:10.4103/0019-5154.174092. PubMed Central
• Mooney E, Mahar P, Howard A. Median canaliform and habit-tic deformity of the nail: is there an association with macrolunulae?. Australas J Dermatol. 2016;57(4):319–20. doi:10.1111/ajd.12377. PubMed
• Pathania V. Median canaliform dystrophy of Heller occurring on thumb and great toe nails. Med J Armed Forces India. 2016;72(2):178–9. doi:10.1016/j.mjafi.2015.06.020. PubMed Central
• Wang C, Lee S, Howard A, Foley P. Coexisting median canaliform nail dystrophy and habit-tic deformity in a patient with atopic dermatitis. Australas J Dermatol. 2020;61(1):e100–1. doi:10.1111/ajd.13084. PubMed

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