From the Guidelines
Lichen planus is characterized by nail changes that typically include longitudinal ridging, thinning, and splitting of the nail plate, with the most distinctive change being pterygium formation, as noted in a recent study 1. The characteristic nail changes in lichen planus occur due to the inflammatory nature of the condition, which affects the nail matrix and nail bed, disrupting normal nail formation. Some common nail manifestations include:
- Onycholysis (separation of the nail from the nail bed)
- Subungual hyperkeratosis
- Longitudinal ridging
- Thinning and splitting of the nail plate
- Dorsal pterygium
- Trachyonychia
- Lateral nail plate thinning
- Onychorrhexis These changes are often accompanied by other symptoms of lichen planus, such as purple, itchy, flat-topped papules on the skin or white, lacy patterns on the mucous membranes, as mentioned in a previous guideline 1. Nail involvement occurs in about 10% of lichen planus cases and may sometimes be the only manifestation of the disease, making it crucial to recognize these characteristic changes for proper diagnosis and treatment, with recent recommendations provided in 1.
From the Research
Characteristic Nail Changes in Lichen Planus
- The most common finding in fingernails is longitudinal ridging (85.2%), followed by nail plate thinning (38.2%) and onycholysis (17.2%) 2.
- In toenails, the most common finding is hyperkeratosis (82.7%) with yellowish discoloration (69.3%) 2.
- Pterygium formation (6.6%) and red lunulae (8.2%) are limited to the fingernails 2.
- Anonychia is associated with severe thinning of the nail plate, retraction of the nail bed or nail plate, residual nail plate, loss of proximal nail fold limits, and onychoatrophy 3.
- Dorsal pterygium is associated with loss of proximal nail fold limits, onychoatrophy, and distal splitting greater than 50% 3.
- Longitudinal ridging is the most common clinical finding, but progressive disease may result in irreversible scarring (dorsal pterygium) or permanent nail loss (anonychia) 4.
Nail Involvement in Lichen Planus
- Nail abnormalities are estimated to occur in around 10% of lichen planus cases 2, 5.
- Nail involvement was independent of age, gender, presence of pruritus, the affected skin area, or the duration of cutaneous lichen planus 2.
- Nail matrix involvement was observed in 85% of cases and 55% had nail-bed involvement 5.
- Twenty-five percent of patients presented severe involvement such as pterygium or anonychia 5.