Twenty Nail Onychomadesis: An Unusual Finding in Cronkhite-Canada Syndrome

The document describes a rare case of Cronkhite-Canada syndrome (CCS) in a 67-year-old Italian man, who presented with unusual nail features of onychomadesis in all 20 nails, along with typical cutaneous hyperpigmentation and severe hair loss. The patient had a history of persistent diarrhea and weight loss, which led to a diagnosis of CCS after gastroscopy and colonoscopy revealed widespread gastrointestinal polyposis and biopsies showed chronic active inflammation. The patient's condition improved with aggressive nutritional support and steroid therapy, and by September 2008, his nails had almost completely regrown. CCS is a rare, non-familial syndrome characterized by gastrointestinal polyposis, diarrhea, hypoproteinemia, weight loss, and ectodermal changes such as skin hyperpigmentation, hair loss, and nail dystrophy. The document highlights that onychomadesis, the detachment of the nail plate from the proximal nail fold due to temporary arrest of nail matrix activity, can be a systemic manifestation of CCS.