Isolated nail lichen planus: An expert consensus on treatment of the classical form

Iorizzo, Matilde; Tosti, Antonella; Starace, Michela; Baran, Robert; Daniel, C. Ralph; Chiacchio, Nilton Di; Goettmann, Sophie; Grover, Chander; Haneke, Eckart; Lipner, Shari R.; Rich, Phoebe; Richert, Bertrand; Rigopoulos, Dimitrios; Rubin, Adam I.; Zaiac, Martin; Piraccini, Bianca Maria

doi:10.1016/j.jaad.2020.02.056

Cited by 59 publications

(66 citation statements)

References 45 publications

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“…As disorders like LP preferentially involve the PNF (and underlying matrix), there is a higher risk of pterygium formation in these disorders. In fact, if not promptly recognized and treated, nail LP has a high potential to cause scarring and pterygium formation [8,9]. We could offer a similar explanation for case 4, where psoriatic lesions were particularly severe over the nail folds and the nail bed, explaining the development of pterygium and anonychia in multiple nails.…”

Section: Discussion/conclusionmentioning

confidence: 81%

Pterygium Complicating Nail Psoriasis and Trachyonychia: Is It Rare?

Grover¹,

Singal²,

Bhattacharya³

2021

Skin Appendage Disord

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Pterygium is an irreversible scarring of the nail matrix resulting in a split nail. The deformity is most often post-traumatic, though it can be the end result of aggressive inflammatory diseases involving the nail matrix like nail lichen planus, graft versus host disease, or autoimmune bullous disorders like cicatricial pemphigoid. It is thought to be a result of lymphocytic inflammation-mediated damage to the nail matrix, initiating a fibrotic process which slowly fuses the nail fold with the nail matrix and bed, destroying the nail plate. We report an interesting observation in a series of patients of various ages with nail and/or skin psoriasis, and trachyonychia associated with pterygium formation in multiple nails. Insidious progression to anonychia was also observed despite initiating adequate treatment. This report highlights the potential of irreversible nail damage occurring in reportedly benign nail conditions like psoriasis and trachyonychia, emphasizing the need for early recognition and aggressive management in such cases.

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Section: Discussion/conclusionmentioning

confidence: 81%

Pterygium Complicating Nail Psoriasis and Trachyonychia: Is It Rare?

Grover¹,

Singal²,

Bhattacharya³

2021

Skin Appendage Disord

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“…The expert consensus is to use 5 or 10 mg/mL depending on disease severity. 11 Injections have to be repeated every 4-5 weeks for a minimum of 4-6 months. Once improvement is observed, the period between injections can be tapered to every 6-8 weeks.…”

Section: Treatmentmentioning

confidence: 99%

“…Patients should be made aware that the use of immunosuppressive medications may not completely reverse some elements of the disease process, as once pterygium and nail atrophy occurs, they tend to be permanent. General measures include trimming of dystrophic nail plates, avoidance of excessive manicuring and optimal moisturizing of the nail folds 11 …”

Section: Nail Involvement In Lichen Planusmentioning

confidence: 99%

Inflammatory nail conditions. Part 2: nail changes in lichen planus and alopecia areata

Yesudian

Berker

2020

Clin Experimental Derm

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“…3 The intralesional route is recommended in the absence of nail bed disease. 3 There is a case report of NLP treatment with chloroquine phosphate, with improvement noted after 10 weeks, and complete remission (20 nails) after 30 weeks. 15 There were no adverse events.…”

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confidence: 99%

Recommendations for treatment of nail lichen planus during the COVID ‐19 pandemic

Ricardo

Lipner

2020

Dermatologic Therapy

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Dermatologists are facing unprecedented challenges due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in caring for their patients. Treatment algorithms utilized prior to the coronavirus disease 2019 (COVID-19) pandemic are no longer applicable. 1 Nail lichen planus (NLP) is a true nail emergency, sometimes with an aggressive course, resulting in scarring, permanent nail loss, and significant impact on daily activities. 2 Treatment of NLP is difficult, and topicals are generally not preferred due to poor nail plate penetration and compliance. 3 Thus, intralesional and systemic therapies are mainstays of T A B L E 1 Studies on nail lichen planus treatments with rates of adverse events/infections Reference Study type Medication (route of administration): dosage (number of patients) Adverse event (n, %) Any infection (n, %) 5 Case report Alitretinoin (oral): 30 mg daily (N = 1) None reported None reported 6 Case series Alitretinoin (oral): 30 mg/day for 3 months and 10 mg/day for 3 months (N = 3) Mild skin dryness (unknown) None reported

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Isolated nail lichen planus: An expert consensus on treatment of the classical form

Cited by 59 publications

References 45 publications

Pterygium Complicating Nail Psoriasis and Trachyonychia: Is It Rare?

Pterygium Complicating Nail Psoriasis and Trachyonychia: Is It Rare?

Inflammatory nail conditions. Part 2: nail changes in lichen planus and alopecia areata

Recommendations for treatment of nail lichen planus during the COVID ‐19 pandemic

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