Nail Unit Lichen Planus

  • Bianca Maria PiracciniEmail author
  • Michela Starace
  • Cosimo Misciali
  • Pier Alessandro Fanti


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.


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

978-3-319-65649-6_7_MOESM1_ESM.pdf (30 kb)
Patient Handout (PDF 22 kb)


  1. 1.
    Alsenaid AA, Eder I, Ruzicka T, Braun-Falco M, Wolf R. Successful treatment of nail lichen planus with alitretinoin: report of 2 cases and review of the literature. Dermatology. 2014;229:293–6.CrossRefGoogle Scholar
  2. 2.
    Baran LR. Yellow nail syndrome and nail lichen planus may be induced by a common culprit. Focus on dental restorative substances. Front Med (Lausanne). 2014;2:46.Google Scholar
  3. 3.
    Baran R, Perrin C. Nail degloving, a polyetiologic condition with 3 main patterns: a new syndrome. J Am Acad Dermatol. 2008;58:232–7.CrossRefGoogle Scholar
  4. 4.
    Baran R, Jancovici E, Sayag J, Dawber RP. Longitudinal melanonychia in lichen planus. Br J Dermatol. 1985;113:369–70.CrossRefGoogle Scholar
  5. 5.
    Cinotti E, Fouilloux B, Perrot JL, Labeille B, Douchet C, Cambazard F. Confocal microscopy for healthy and pathological nail. J Eur Acad Dermatol Venereol. 2014;28:853–8.CrossRefGoogle Scholar
  6. 6.
    Goettmann S, Zaraa I, Moulonguet I. Nail lichen planus: epidemiological, clinical, pathological, therapeutic and prognosis study of 67 cases. J Eur Acad Dermatol Venereol. 2012;26:1304–9.CrossRefGoogle Scholar
  7. 7.
    Iorizzo M. Nail lichen planus – a possible new indication for oral alitretinoin. J Eur Acad Dermatol Venereol. 2016;30(3):509–10.CrossRefGoogle Scholar
  8. 8.
    Juhlin L, Baran R. Longitudinal melanonychia after healing of lichen planus. Acta Derm Venereol. 1989;69:338–9.PubMedGoogle Scholar
  9. 9.
    Kato Y, Hayakawa R, Shiraki R, Ozeki K. A case of lichen planus caused by mercury allergy. Br J Dermatol. 2003;148:1268–9.CrossRefGoogle Scholar
  10. 10.
    Khullar G, Handa S, De D, Saikia UN. Bullous lichen planus of the nails. JAMA Dermatol. 2015;151:674–5.CrossRefGoogle Scholar
  11. 11.
    Nakamura R, Broce AA, Palencia DP, Ortiz NI, Leverone A. Dermatoscopy of nail lichen planus. Int J Dermatol. 2013;52:684–7.CrossRefGoogle Scholar
  12. 12.
    Nishizawa A, Satoh T, Yokozeki H. Close association between metal allergy and nail lichen planus: detection of causative metals in nail lesions. J Eur Acad Dermatol Venereol. 2013;27(2):e231–4.CrossRefGoogle Scholar
  13. 13.
    Pandhi D, Singal A, Bhattacharya SN. Lichen planus in childhood: a series of 316 patients. Pediatr Dermatol. 2014;31:59–67.CrossRefGoogle Scholar
  14. 14.
    Pinter A, Pätzold S, Kaufmann R. Lichen planus of nails – successful treatment with Alitretinoin. J Dtsch Dermatol Ges. 2011;9:1033–4.Google Scholar
  15. 15.
    Piraccini BM, Saccani E, Starace M, Balestri R, Tosti A. Nail lichen planus: response to treatment and long term follow-up. Eur J Dermatol. 2010;20:489–96.Google Scholar
  16. 16.
    Piraccini BM, Bruni F, Starace M. Dermoscopy of non-skin cancer nail disorders. Dermatol Ther. 2012;25:594–602.CrossRefGoogle Scholar
  17. 17.
    Renker T, Haneke E, Röcken C, Borradori L. Systemic light-chain amyloidosis revealed by progressive nail involvement, diffuse alopecia and sicca syndrome: report of an unusual case with a review of the literature. Dermatol. 2014;228:97–102.CrossRefGoogle Scholar
  18. 18.
    Richert B, André J. Trachyonychia: a clinical and histological study of 22 cases. J Eur Acad Dermatol Venereol. 1999;12:126.CrossRefGoogle Scholar
  19. 19.
    Sanli H, Arat M, Oskay T, Gürman G. Evaluation of nail involvement in patients with chronic cutaneous graft versus host disease: a single-center study from Turkey. Int J Dermatol. 2004;43:176–80.CrossRefGoogle Scholar
  20. 20.
    Scalf LA, Fowler JF Jr, Morgan KW, Looney SW. Dental metal allergy in patients with oral, cutaneous, and genital lichenoid reactions. Am J Contact Dermat. 2001;12(3):146–50.PubMedGoogle Scholar
  21. 21.
    Scher RK, Fischbein R, Ackerman AB. Twenty-nail dystrophy: A variant of lichen planus. Arch Dermatol. 1978;114:612–3.CrossRefGoogle Scholar
  22. 22.
    Shiohara T, Kano Y. Lichen planus. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 2nd ed. London: Mosby Elsevier; 2008. p. 511.Google Scholar
  23. 23.
    Suarez SM, Scher RK. Idiopathic atrophy of the nails: a possible hereditary association. Pediatr Dermatol. 1990;7:39–41.CrossRefGoogle Scholar
  24. 24.
    Tosti A, Peluso AM, Fanti PA, Piraccini BM. Nail lichen planus: clinical and pathologic study of twenty-four patients. J Am Acad Dermatol. 1993;28:724–30.CrossRefGoogle Scholar
  25. 25.
    Tosti A, Bardazzi F, Piraccini BM, et al. Idiopathic trachyonychia (twenty-nail dystrophy): a pathological study of 23 patients. Br J Dermatol. 1994;131:866–72.CrossRefGoogle Scholar
  26. 26.
    Tosti A, Piraccini BM, Fanti PA, Bardazzi F, Di Landro A. Idiopathic atrophy of the nails: clinical and pathological study of 2 cases. Dermatology. 1995;190:116–8.CrossRefGoogle Scholar
  27. 27.
    Tosti A, Ghetti E, Piraccini BM, Fanti PA. Lichen planus of the nails and fingertips. Eur J Dermatol. 1998;8:447–8.PubMedGoogle Scholar
  28. 28.
    Tosti A, Piraccini BM, Cameli N. Nail changes in lichen planus may resemble those of yellow nail syndrome. Br J Dermatol. 2000;142:848–9.CrossRefGoogle Scholar
  29. 29.
    Tosti A, Piraccini BM, Cambiaghi S, Jorizzo M. Nail lichen planus in children: clinical features, response to treatment, and long-term follow-up. Arch Dermatol. 2001;137:1027–32.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Yokozeki H, Niiyama S, Nishioka K. Twenty-nail dystrophy (trachyonychia) caused by lichen planus in a patient with gold allergy. Br J Dermatol. 2005;152(5):1087–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

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

Personalised recommendations