Severe Onycholysis in a Card Illusionist with Alopecia Areata Universalis

A 23-year-old card illusionist with alopecia areata universalis developed severe onycholysis, which significantly impacted his ability to work. Treatment with systemic steroids (triamcinolone acetonide) for 3 months led to rapid improvement and complete normalization of his nails within 6 months, although mild recurrence was noted after 1 year. Nail abnormalities in alopecia areata are common but usually not severe, and systemic steroids proved effective in this severe case.