​Dermatology - Nail Findings of Lichen Planus

​Dermatology - Nail Findings of Lichen Planus 
Approximately 10% of persons with disseminated lichen planus experience nail involvement, which can result in the destruction of the nails. In other cases, nail lesions may be the sole indication of the condition. The condition known as "twenty-nail syndrome" refers to the involvement of one, few, or all 20 nails, resulting in the loss of all nails without any other signs of lichen planus elsewhere on the body.

Onychorrhexis, characterized by longitudinal ridging and fissuring of the nail plate resulting in brittleness and breakage, is observed. However, it should be noted that this is not a distinctive feature and can also occur as a result of aging. Similar alterations occur in lichenoid graft-versus-host disease. Swelling and blue/red staining of the proximal nail fold are observed on the skin's dorsum.

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A minor concentration may be observed in the matrix, manifesting as a protrusion beneath the proximal nail fold and a following vertical red line: The nail plate becomes thinner and develops a split at the distal end, a condition known as onychorrhexis. Matrix involvement refers to the scattered and specific degeneration of the nail plate, characterized by onychorrhexis (nail splitting) and/or transverse splitting. A red lunula can be either localized or widespread, and temporary longitudinal melanonychia may occur. There is a possibility of a total nail fracture. Pterygium development refers to the partial loss of the central nail plate, resulting in the destruction of the underlying matrix. This condition is characterized by a V-shaped extension of skin from the proximal nail fold that is firmly attached to the nail bed. The rapid and ongoing destruction of the nails, resulting in widespread nail shrinkage with or without the formation of a fold of skin over the nail (pterygium), ultimately leads to the total absence of nails (anonychia). Ulcerative lichen planus is characterized by the presence of bullae, erosions, bleeding, and scarring. In this variant, skin lesions typically occur on the palms and soles.
The disease has different forms, such as 20-nail dystrophy of childhood, which goes away on its own; lichen planus-like eruptions that occur after a bone marrow transplant in graft-versus-host disease; drug-induced reactions that resemble lichen planus, and permanent anonychia as the sole manifestation of lichen planus.

Observation of the physical manifestation and presence of LP lesions in other areas of the body. The differential diagnosis include all nail illnesses characterized by destruction, such as psoriasis, Darier disease, and onychomycosis.


Manage nail lesions by using intralesional triamcinolone and systemic glucocorticoids.