From the Guidelines
The characteristic nail change in lichen planus is thinning of the nail plate, subungual hyperkeratosis, onycholysis, and dorsal pterygiium, occurring in approximately 10% of affected individuals. These changes are due to the inflammatory nature of the disease affecting the nail matrix, leading to disruptions in normal nail formation 1. Some key clinical characteristics of nail lichen planus include:
- Thinning of the nail plate
- Subungual hyperkeratosis
- Onycholysis
- Dorsal pterygiium It is essential to differentiate these changes from other conditions that may mimic onychomycosis, such as fungal or bacterial infections, traumatic nail changes, or other dystrophic nail conditions 1. In clinical practice, a thorough examination of the nail and surrounding tissue is necessary to accurately diagnose nail lichen planus and initiate appropriate treatment, which typically involves controlling the underlying inflammation with topical or systemic corticosteroids 1.
From the Research
Characteristic Nail Changes in Lichen Planus
- The most common clinical finding in nail lichen planus is longitudinal ridging, as reported in 2 and 3.
- Other common nail changes include nail plate thinning, onycholysis, pterygium formation, and red lunulae, as noted in 3.
- In toenails, hyperkeratosis with yellowish discoloration is a common finding, as observed in 3.
- Severe nail lichen planus may result in irreversible scarring (dorsal pterygium) or permanent nail loss (anonychia), as mentioned in 2 and 4.
- 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, as described in 4.
Nail Involvement in Lichen Planus
- Nail abnormalities are estimated to occur in around 10% of lichen planus cases, as stated in 3.
- Nail involvement may be independent of age, gender, presence of pruritus, affected skin area, or duration of cutaneous lichen planus, as reported in 3.
- Matrix involvement is more frequent than nail bed involvement in fingernails, as observed in 3.