Lichen Planus (ungual findings)

Diagnosis: Lichen Planus (ungual findings)

Longitudinal ridges of the nails.

Clinical Presentation

Longitudinal ridges of the nails.

Clinical History

Submitted by Alaa Saad. Originally posted September 13, 2010.

Treatment

See case discussion.

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: lichen, planus, ungual, findings, alaa saad