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

Abstract

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 Treatment algorithms utilized prior to the coronavirus disease 2019 (COVID-19) pandemic are no longer applicable. 1 Nail lichen planus (NLP) is a true nail emergency, sometimes with an aggressive course, resulting in scarring, permanent nail loss, and significant impact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

Antifungal Selection for the Treatment of Onychomycosis: Patient Considerations and Outcomes

“…25 It was FDA-approved in 1995 for dermatophyte onychomycosis treatment, with oral dosing of 200mg daily for 12 weeks for toenails and two treatment pulses of 200mg twice daily for 1 week separated by 3 weeks for fingernails. 4,26 Itraconazole demonstrates broad-spectrum activity against dermatophytes, non-dermatophyte molds, and candida species. The oral formulation of itraconazole has 55% bioavailability, though maximal absorption occurs in acidic gastric environments.…”

Recommendations on trichological treatments during COVID-19 pandemic

“…Interestingly, retinoids possess in vitro antiviral effects, which have been observed on human herpesvirus-8, human immunodeficiency virus type I, herpes-simplex virus 1, polyomavirus, hepatitis B virus, hepatitis C virus. However, their effect on SARS-CoV-2 is unknown (17). Since the lack of evidence concerning retinoids and COVID-19, and considering the hypothesized antiviral properties of retinoids, their administration can be considered safe in trichological patients.…”

Practical commentary on therapeutic guidelines for isolated nail lichen planus 2020

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dopuszczalne uznano między innymi próby leczenia za pomocą silnych miejscowych glikokortykosteroidów stosowanych pod okluzją (co eliminuje konieczność cyklicznych wizyt lekarskich) [9].

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“…Recently, new therapeutic guidelines for the treatment of NLP during the COVID pandemic have been published, in which attempts of therapy with strong topical glucocorticosteroids used under the occlusion (which eliminates the need for regular medical visits) were deemed acceptable [9].…”