Nail abnormalities are present in ~10% of patients with lichen planus. However, nail lichen planus is most frequently seen in the absence of skin, scalp, or mucosal involvement. In a study of 24 adults with nail lichen planus, nail changes were the sole manifestation of the disease in 75%, and the proportion may be higher in children.
Clinical findings that are diagnostic include nail thinning, atrophy, longitudinal ridging and fissuring, and dorsal pterygium (due to scarring). Several nails are usually affected. The presence of onychorrhexis and thinning indicates matrix involvement and the need for prompt treatment to avoid scarring. Dorsal pterygium results from adhesion of the proximal nail fold to the nail bed due to matrix destruction and disappearance of the nail plate.
- A Tosti, AM Peluso, PA Fanti, et al.: Nail lichen planus: clinical and pathologic study of twenty-four patients. J Am Acad Dermatol. 28:724-730；1993
- Antonella Tosti, Bianca Maria Piraccini. In: Jean Bolognia Julie Schaffer Lorenzo Cerroni, editors. Dermatology: 2-Volume Set 4th Edition. Elsevier; 2017. p1217
- Tosti A, Peluso AM, Fanti PA, et al. Nail lichen planus. Clinical and pathological study of 24 patients. J Am Acad Dermatol 1993;28:724–3
- Tosti A, Fanti PA, Morelli R, et al. Trachyonychia associated with alopecia areata. A clinical and pathological study. J Am Acad Dermatol 1991;25:266–70