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Nail Unit Lichen Planus

  • Bianca Maria Piraccini
  • Michela Starace
  • Cosimo Misciali
  • Pier Alessandro Fanti
Chapter

Abstract

Nail abnormalities are seen in approximately 10% of adult patients with cutaneous lichen planus, but in most of the cases nail LP is not associated with skin or mucosal lesions, a mild oral LP being detected in less then one-fourth of the patients only after examination. Most commonly, nail LP involves the nail matrix and presents with nail thinning with longitudinal ridging and fissuring (onychorrhexis) that usually involve several-all nails. Dorsal pterygium is a possible outcome and indicates focal scarring of the nail matrix. Unless the patient has clinical signs of LP of the skin of mucosae, diagnosis of nail LP requires a biopsy, as the differential diagnosis is not always easy clinically. Moreover, as treatment of nail LP requires systemic or intralesional drugs, in order to avoid permanent scarring, having a pathological confirmation of the diagnosis helps to increase patient’s acceptance of therapy. Treatment of nail LP is difficult, as not all patients respond to therapy. Optimal therapy is still lacking, and systemic or intralesional steroids (the choice is based on the numbers of nails involved) are the treatment of choice.

Keywords

Lichen planus Dorsal pterygium Nail fissuring Trachyonychia Nail degloving Yellow-nail syndrome-like nail changes Onychoscopy Lichenoid infiltrate Systemic steroids Intralesional steroids Alitretinoin 

Supplementary material

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Bianca Maria Piraccini
    • 1
  • Michela Starace
    • 1
  • Cosimo Misciali
    • 1
  • Pier Alessandro Fanti
    • 1
  1. 1.Dermatology, Department of Experimental, Diagnostic and Specialty MedicineUniversity of BolognaBolognaItaly

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