Nail Changes in Lichen Planus: A Single-Center Study

Abstract

Background Lichen planus (LP) is an inflammatory condition that can affect skin, mucous membranes, hair follicles, and/or nails. Nail abnormalities are estimated to occur in around 10% of LP cases. Clinical characteristics of nail involvement have been the subject of very few studies, which have mainly focused on isolated nail LP. Objectives To identify and describe nail alterations in patients with LP. Methods Seventy-five patients with cutaneous lichen planus (CLP) were included in the study. The diagnosis of LP was histologically confirmed in each case. Onychomycosis was excluded in each patient. Results Nail lesions were present in 21 (28%) patients (mean age 58.1 ± 12.55 years) with CLP. On an average, patients had 9.38 nails affected. A slight female preponderance was noted (57%). Nail involvement was independent of age, gender, presence of pruritus, the affected skin area, or the duration of CLP. The most common finding in the fingernails ( n = 122) was longitudinal ridging (85.2%), followed by nail plate thinning (38.2%) and onycholysis (17.2%). Pterygium formation (6.6%) and red lunulae (8.2%) were limited to the fingernails. In the fingernails, matrix involvement (98.4%) was more frequent than nail bed involvement (27%). The most common finding in the toenails ( n = 75) was hyperkeratosis (82.7%) with yellowish discoloration (69.3%). No cases of trachyonychia or anonychia were noted. Conclusions Nail abnormalities in patients with CLP may be more common than initially assessed. Rare formation of pterygium and absence of anonychia in patients with predominant cutaneous involvement might point at mild course of the nail disease in such cases.

Study of Clinical and Dermoscopic Features in Nails of Papulosquamous Disorders and their Correlation with Disease Severity

“…In this study, there was female predominance which was similar to the study by Żychowska and Żychowska,[ 14 ] and Sharma et al . [ 15 ] The age group most commonly affected was 31–45 years, which was comparable to studies by Kanvar et al .…”

“…[ 15 ] The age group most commonly affected was 31–45 years, which was comparable to studies by Kanvar et al . [ 16 ] Mean age was 32.71 ± 11.56 years which was less compared to that in the study by Zychowska and Zychowska[ 14 ] (53.27 ± 15.75 years), Wechsuruk et al .,[ 17 ] and Sharma et al . [ 15 ] Type of lichen planus and gender had significant relation with nail changes ( P < 0.05).…”

“…Age, duration of disease, and BSA had no relation with nail changes. In a study by Zychowska and Zychowska,[ 14 ] they found that nail involvement was independent of age, gender, presence of pruritus, the affected skin area, or the duration of CLP.…”

Clinical features and treatment outcomes of nail lichen planus: A retrospective study

“…It therefore follows that in Asian patients, the presence of melanonychia in many nails, especially fingernails, along with other common clinical characteristics of nail lichen planus, should signal the possibility of nail lichen planus. The studies of Goettmann et al 1 and Żychowska et al 6 described very similar levels of nail matrix and nail bed involvement. The present study found higher proportions of red lunula and trachyonychia, both of which indicate the presence of severe nail abnormalities ( Table II ).…”

Dermoscopy of Gottron’s papules and other inflammatory dermatoses involving the dorsa of the hands

“…Lichen planus is a relatively common inflammatory dermatosis characterized by a wide variety of clinical variants 23–25 . Dermoscopic aspects of LP have been the subject of several studies, so far 26–30 .…”