A follow-up study was performed to determine the outcomes of all patients (five males and seven females, mean age 18.4 years) who were referred to a specialist nail clinic with trachyonychia. The average number of affected nails per patient was 8.8 fingernails and 6.2 toenails. None of our patients tested positive for onychomycosis. Nail biopsies were performed in two patients, revealing non-specific changes. Eight patients did not present with or develop accompanying skin or mucosal disease. Two patients presented with alopecia areata and two others with psoriasis. Of our patients, 50% showed total resolution or marked improvement in their nail disease within the first 6 years regardless of treatment.