Twenty-nail distrophy (TND), poznana tudi kot trachyonychia (hrapav noht). Gre za razširjeno trachyonichio, pri kateri so vključeni vsi nohti na rokah kot tudi na nogah. Na nohtih so videti vzdolžne brazde, ki mu dajejo grob ali zlomljen videz. Površina nohta je hrapava ter brez sijaja, nohti so krhki in tanki. V blagih primerih se skoraj vedno opazi valovanje nohta. V hudih primerih lahko TND nohtom daje izgled brusnega papirja. Povzročajo jo različne vnetne bolezni, ki prizadenejo keratinizacijo (proces, kjer se celice postopoma izoblikujejo) npr. luskavica, alopecija areata, lichen planus, atopični dermatitis, vitiligo. Najpogosteje se pojavlja pri otrocih, kjer je po navadi neznanega vzr
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