Lichen planus nails

Diagnosis: Lichen planus nails

Lichen planus

Clinical Presentation

Lichen planus

Clinical History

Pruritic, violaceous, polygonal papules on wrists, ankles, and oral mucosa. Check medications (lichenoid drug eruption). Evaluate for hepatitis C. Assess for nail and scalp involvement.

Treatment

Topical corticosteroids (first-line). Oral lichen planus: topical tacrolimus or clobetasol gel. Severe/widespread: systemic corticosteroids, acitretin, phototherapy. Erosive oral LP: cyclosporine rinse. Hepatitis C treatment if positive.

Differential Diagnosis

• Drug-induced lichenoid eruption • Psoriasis (guttate) • Pityriasis rosea • Secondary syphilis • Eczema • Lichen nitidus • Lichenoid keratosis • Graft-versus-host disease

Key Learnings

• Remember the 6 P's: Pruritic, Purple, Polygonal, Planar (flat-topped), Papules, Plaques • Wickham striae (fine white lines on surface) are pathognomonic — best seen with dermoscopy • Koebner phenomenon: lesions at sites of trauma • Oral LP: most common mucosal form — reticular (lacy white striae) vs. erosive • Erosive oral LP has a small risk of SCC transformation — requires monitoring • Hepatitis C association varies geographically — screening recommended • Histology: interface dermatitis with band-like lymphocytic infiltrate, sawtooth rete ridges, Max Joseph spaces (civatte bodies)

Tags: case, dermatology, kodachrome, Lichen planus, nails