Bullous Lichen Planus With Onychatrophy

“…The disease affects fingernails more often than toenails, 9 involving two to three fingernails initially 9 . Distinctive clinical variants of nail LP include nail matrix disease, nail bed disease, trachyonychia, idiopathic atrophy of the nails, and bullous‐erosive LP 10‐12 …”

Section: Introductionmentioning

confidence: 99%

“…9 Distinctive clinical variants of nail LP include nail matrix disease, nail bed disease, trachyonychia, idiopathic atrophy of the nails, and bullous-erosive LP. [10][11][12] Although any part of the nail unit 4,13 can be involved, the matrix is preferentially involved. 14 Nail bed involvement has been reported to be more common in toenails as compared to fingernails.…”

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confidence: 99%

Histopathological evaluation of nail lichen planus: A cross‐sectional study

et al. 2020

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Introduction: Up to 10% of patients with lichen planus (LP) have nail involvement; still there is a paucity of studies on histopathological features. Nevertheless, nail biopsy is the diagnostic standard, especially for isolated nail LP. Methodology: Nails of 45 patients with nail LP were evaluated clinically and biopsies taken from most involved nail (25 nail bed and 20 matrix biopsies). Correlation of clinical and histopathological features was also done. Results: The mean age of the study group participants was 36.91 ± 18.27 years with a M:F ratio of 1.81:1. The most common clinical variant of LP seen was oral LP (51%), with isolated nail involvement in 29%. Clinically, major features were onychorrhexis (92.3%), longitudinal melanonychia (74.3%), and nail bed erythema (54%). Histopathologically, hypergranulosis of nail matrix and bed epithelium (51.1%), followed by sawtooth acanthosis (44.4%) and lichenoid band (24.4%) were most common. A diagnosis using prevalent diagnostic criteria was confirmed in 51.1% biopsies. Distinctive "fraying of nail plate," a change not previously described, was noted in 33.3% cases. Conclusion: Histopathology of nail LP has been attributed a diagnostic role; however, existing diagnostic criteria are not sensitive enough and need refinement. Not hitherto described features like fraying of nail plate are seen in a significant number of cases. K E Y W O R D S lichen planus, nail bed biopsy, nail lichen planus, nail matrix biopsy 1 | INTRODUCTION Nail involvement can be seen in up to 10% of patients with lichen planus (LP), 1-7 with permanent nail dystrophy or nail loss occurring in approximately 4% of patients. 4 Nail LP is often associated with involvement of other mucocutaneous sites, 8 though isolated nail involvement can be seen in a significant number of cases. The disease affects fingernails more often than toenails, 9 involving two to three fingernails initially. 9 Distinctive clinical variants of nail LP include nail matrix disease, nail bed disease, trachyonychia, idiopathic atrophy of the nails, and bullous-erosive LP. 10-12 Although any part of the nail unit 4,13 can be involved, the matrix is preferentially involved. 14 Nail bed involvement has been reported to be more common in toenails as compared to fingernails. On the other hand, matrix involvement is more commonly seen in fingernails. 8,13 LP of nail matrix is a slowly progressive but potentially scarring disease, dreaded complications being permanent anonychia and pterygium formation. Hence, an early diagnosis and appropriate therapy are of utmost importance.

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“…Nail BLP has been described in 7 other case reports, as well as 1 case series including 14 patients with nail involvement (shown in Table 1 ) [ 4 – 6 , 8 – 10 ]. These cases have had variable involvement of the fingernails (50.0%) and/or toenails (70.0%), with an average of 5.5 years to diagnosis (range 2 months–13 years).…”

Section: Discussionmentioning

confidence: 99%

Bullous Lichen Planus of the Nails: A Case Report and Review of the Literature

Hwang,

Magro,

Lipner

2023

Case Rep Dermatol

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Lichen planus is a chronic inflammatory disorder that may affect the skin, nails, and/or oral mucosa. Bullous lichen planus is a rare variant of lichen planus, which is even less common in the nails. We present a case of nail bullous lichen planus, in a 48-year-old male presenting with a 10-month history of onychodystrophy of all ten fingernails. A longitudinal excision of the left thumbnail was performed, with histopathology consistent with lichen planus with focal transition to bullous lichen planus. He was treated with intralesional triamcinolone injections to the fingernails monthly, with improvements noted after three treatments. Our patient’s nail bullous lichen planus manifested with longitudinal ridging, white-yellow discoloration, onycholysis, subungual hyperkeratosis, and v-shaped nicking. Histopathological findings included classical lichen planus changes, as well as formation of subepidermal bullae, colloid bodies, and extensive inflammatory infiltrate. Increased awareness and high index of suspicion for this condition are necessary, given the often late diagnosis reported in previously published cases.

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Bullous Lichen Planus With Onychatrophy

Cited by 14 publications

References 2 publications

The Nail in Lichen Planus

The Nail in Lichen Planus

Histopathological evaluation of nail lichen planus: A cross‐sectional study

Bullous Lichen Planus of the Nails: A Case Report and Review of the Literature

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