Nail lichen planus: a patient with atypical presentation

Abstract

Lichen planus is a common chronic inflammatory dermatosis characterized by small, violaceous, flat-topped polygonal papules mostly seen on the flexural wrists and ankles. Several variants of lichen planus have been described based on either morphological appearance, configuration of the lesions or site of the involvement. Moreover, lichen planus is a distinctive dermatosis, in which mucosal or nail involvement may develop in the absence of cutaneous involvement. It has been estimated that nails are affected up to 10% of all patients with lichen planus. The most specific and unique nail finding of lichen planus is the pterygium formation. Pterygium unguis also known as dorsal pterygium refers to a V-shaped extension of the proximal nail fold over the nail plate, which eventually produces permanent onychatrophy. Here, we describe a patient with pterygium unguis, who also manifests atypical mucosal and cutaneous lesions of lichen planus.

Dermatology Eponyms – sign –Lexicon (W)

“…12). There are delicate white or grey lines that course the surface of a papule of lichen planus [39]. The lines may be seen only at the periphery of a papule, but usually they form a network across the entire papule.…”

Lichen Planus: A Muco-Cutaneous, Nails and Scalp Disorder – Cases Report

“…The matrix and the nail bed are affected by the chronic inflammatory process, leading to an evolutive destruction with the formation of lateral thinning, longitudinal ridging and striations (onychorrhexis), fissuring, distal splitting (onychoschizia), subungual hyperkeratosis, onycholysis, trachyonychia, erythematous patches of the lunula up to onychatrophy and pterygium unguis -the most common form in which all nails are sometimes affected, leading to complete nail dystrophy. (6) Palmoplantar lichen planus is a form rarely described in the literature, with different morphology compared to the classical forms, being difficult to diagnose. The following clinical variants have been described: erythematous scaly form (which is the most common), pitted plaques, ulcerative lesions, vesicle-like papules, umbilicated papules, punctate keratoderma, diffuse keratoderma, perforating palmar LP and petechiae-like lesions, hypertrophic, keratotic plaque.…”