Lichen Planus of the Nails

Lichen planus of the nails, also known as lichen planus unguium, is a chronic autoimmune skin condition that affects the nails. It is characterized by the formation of distinct and painful white or reddish-purple raised patches on the nails, which can lead to thickening and distortion of the nails. This condition is relatively uncommon, affecting only about 2% of individuals with lichen planus, but it can be a significant source of discomfort and cosmetic concern for those affected.

In this article, we will provide a comprehensive list of definitions for the key terms associated with lichen planus of the nails.

  1. Lichen Planus: A common autoimmune skin condition characterized by the formation of small, itchy, and painful purple or white raised patches on the skin.
  2. Autoimmune Disorder: A condition in which the body’s immune system mistakenly attacks its own tissues, causing inflammation and damage.
  3. Nails: The protective coverings of the tips of the fingers and toes that are made up of keratin, a protein that is also found in hair and skin.
  4. Distortion: A change in the normal shape or appearance of the nails, caused by lichen planus of the nails.
  5. Thickening: An increase in the thickness of the nails, which can occur as a result of lichen planus of the nails.
  6. White Patches: The characteristic white or reddish-purple raised patches that form on the nails as a result of lichen planus.
  7. Painful: Describing a condition that causes discomfort or pain, such as lichen planus of the nails.
  8. Chronic: A long-lasting condition that persists over time, such as lichen planus of the nails.
  9. Inflammation: A response of the body’s immune system to injury or infection, characterized by redness, swelling, and pain.
  10. Raised Patches: Areas of skin that are raised above the surrounding tissue, such as the white or reddish-purple patches that form on the nails as a result of lichen planus.
  11. Itchy: Describing a condition that causes itching or discomfort, such as lichen planus of the nails.
  12. Purple Patches: The characteristic white or reddish-purple raised patches that form on the nails as a result of lichen planus.
  13. Onycholysis: A condition in which the nails separate from the nail bed, causing them to become thin and brittle.
  14. Deformity: A change in the normal shape or appearance of the nails, caused by lichen planus of the nails.
  15. Brittle: Describing nails that are weak and prone to breaking or cracking easily.
  16. Nail Bed: The area beneath the nails where the nails are attached to the underlying skin.
  17. Separation: A condition in which the nails separate from the nail bed, causing them to become thin and brittle.
  18. Fragile: Describing nails that are weak and prone to breaking or cracking easily.
  19. Proximal Onycholysis: A condition in which the nails separate from the nail bed near the base of the nails.
  20. Distal Onycholysis: A condition in which the nails separate from the nail bed near the tips of the nails.
  21. Nail Plate: The visible portion of the nails, including the surface and edges.

Causes

It is a multifactorial condition, meaning it is caused by a combination of genetic, environmental, and lifestyle factors. The exact cause of lichen planus is still unknown, but various theories have been proposed to explain its development.

In this article, we will discuss the main causes of lichen planus of the nails and their underlying mechanisms.

  1. Genetics

Studies have shown that lichen planus has a hereditary component, suggesting a genetic predisposition to the condition. People with a family history of lichen planus are more likely to develop the condition than those without a family history. However, the specific genes responsible for the development of lichen planus have not yet been identified.

  1. Environmental triggers

Environmental triggers play a significant role in the development of lichen planus. Exposure to certain chemicals, such as hair dyes, dental restorations, and topical medications, has been linked to the development of lichen planus. Additionally, exposure to certain metals, such as mercury, silver, and gold, has also been associated with the condition.

  1. Infections
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Infections, especially viral infections, have been linked to the development of lichen planus. The hepatitis C virus is the most commonly identified infection associated with lichen planus, although other viruses, such as the human papillomavirus, have also been implicated.

  1. Immune system dysfunction

Lichen planus is an autoimmune condition, meaning it is caused by an abnormal immune response to the body’s own tissues. In lichen planus, the immune system attacks the skin cells, leading to the formation of raised, itchy, and scaly patches. The exact mechanism by which the immune system becomes dysregulated in lichen planus is still not well understood, but it is thought to be related to genetic predisposition, environmental triggers, and infections.

  1. Hormonal imbalances

Hormonal imbalances have also been linked to the development of lichen planus. Women are more likely to develop lichen planus during pregnancy and menopause, suggesting a role for hormonal factors in the development of the condition.

  1. Stress

Stress has been linked to the development of lichen planus, although the exact mechanism by which stress triggers the condition is still not well understood. Stress can cause hormonal imbalances, immune system dysfunction, and exposure to environmental triggers, all of which can contribute to the development of lichen planus.

  1. Nutrition

Nutritional deficiencies, such as deficiencies in vitamins and minerals, have been linked to the development of lichen planus. For example, a deficiency in vitamin B12 has been associated with the development of lichen planus, and supplementation with vitamin B12 has been shown to improve the symptoms of the condition.

Symptoms

Lichen planus is a chronic skin condition that affects the skin, hair, and nails. It is characterized by itchy, purplish, flat-topped bumps that form on the skin or mucous membranes. In some cases, the condition can affect the nails, causing a range of symptoms.

The following are the main symptoms of lichen planus of the nails:

  1. Nail changes: The nails may become thickened, ridged, brittle, or discolored. In some cases, the nails may develop white lines or spots, and they may also become misshapen.
  2. Nail separation: One of the most common symptoms of lichen planus of the nails is separation of the nail from the nail bed. This separation is often accompanied by pain and can result in the development of a fungal infection.
  3. Nail fragility: The nails may become fragile and break easily, which can be uncomfortable and unsightly.
  4. Nail deformities: The nails may become misshapen, with ridges or bumps appearing on the surface. In severe cases, the nails may become completely destroyed, leading to complete loss of the nail.
  5. Nail discoloration: The nails may become yellow, brown, or white in color, and they may also have a yellowish-brown streak along the length of the nail.
  6. Nail growth changes: The nails may grow more slowly than normal, or they may stop growing altogether. This can result in the nails becoming shorter and more brittle.
  7. Nail pitting: Pitting or indentations may form on the surface of the nails, which can be a sign of lichen planus of the nails.
  8. Onycholysis: This is a condition in which the nail becomes separated from the nail bed. This can result in the development of an infection, and it can also cause the nail to become discolored and brittle.
  9. Nail bed changes: The nail bed may become red and inflamed, which can result in pain and discomfort.
  10. Nail matrix changes: The nail matrix is the area of the nail that is responsible for producing new nail cells. If this area is affected by lichen planus, it can result in changes to the appearance and growth of the nails.
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In order to diagnose lichen planus of the nails, a healthcare provider will perform a physical examination and may also take a sample of the affected skin or nail for laboratory analysis. In some cases, a biopsy of the nail may be necessary in order to make a definitive diagnosis.

Diagnosis

The diagnosis and tests for lichen planus of the nails are important to identify the underlying cause of the condition and to prevent further complications.

  1. Physical Examination

A physical examination is the first step in diagnosing lichen planus of the nails. A dermatologist or a specialist will examine the affected nails, looking for any signs of discoloration, ridges, or pits. They will also examine the surrounding skin for any eruptions, itching, or redness. The physical examination helps the doctor determine the extent of the condition and the severity of the symptoms.

  1. Nail Clipping

A nail clipping test is a simple procedure that involves clipping a small piece of the affected nail and examining it under a microscope. The doctor will look for any signs of inflammation, fungal infections, or other conditions that may be causing the symptoms. This test is a quick and non-invasive way to diagnose lichen planus of the nails.

  1. Skin Biopsy

A skin biopsy is a procedure that involves removing a small piece of skin from the affected area and examining it under a microscope. This test is more invasive than a nail clipping test, but it provides more information about the underlying cause of the condition. The biopsy can also help rule out other conditions that may be causing similar symptoms.

  1. Blood Tests

Blood tests are often used to diagnose autoimmune conditions like lichen planus. The doctor may order a complete blood count (CBC) to check for any signs of inflammation or infection. They may also order tests that measure the levels of certain antibodies in the blood. These tests help the doctor determine if the body is producing an immune response to the condition.

  1. Patch Tests

Patch tests are a type of skin test that involves applying a small amount of a suspected allergen to the skin and observing the reaction. This test is used to determine if an allergy is causing the symptoms of lichen planus. The doctor may use a variety of allergens, including fragrances, dyes, and certain types of metals.

  1. Wood’s Lamp Test

A Wood’s lamp test is a type of ultraviolet light test that is used to diagnose fungal infections of the nails. The doctor will shine the light on the affected nails and look for any signs of fluorescence. This test is a quick and simple way to diagnose fungal infections, which can often be mistaken for lichen planus.

  1. KOH (Potassium Hydroxide) Test

A KOH test is a simple test that is used to diagnose fungal infections of the nails. The doctor will take a sample of the affected nail and dissolve it in a solution of KOH. The solution is then examined under a microscope to look for any signs of fungal cells. This test is a quick and non-invasive way to diagnose fungal infections, which can often be mistaken for lichen planus.

  1. Culture Test

A culture test is a more invasive test that involves taking a sample of the affected nail and growing it in a laboratory. This test is used to identify the type of fungus that is causing the infection. The doctor will use this information to prescribe the appropriate treatment.

  1. Rheumatoid Factor (RF) Test
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A rheumatoid factor (RF) test is a blood test that measures the levels of RF in the blood.

Treatment

The treatment of lichen planus of the nails depends on the severity of the symptoms and the impact they have on the individual’s quality of life. The following are the main treatments for lichen planus of the nails:

  1. Topical corticosteroids: Corticosteroids are anti-inflammatory drugs that can help to reduce the inflammation and itching associated with lichen planus. They can be applied directly to the affected nail in the form of creams, gels, or ointments. Topical corticosteroids are the most commonly used treatment for lichen planus of the nails. They work by suppressing the immune system and reducing the inflammation that is causing the symptoms.
  2. Topical calcineurin inhibitors: Calcineurin inhibitors are drugs that suppress the immune system and reduce inflammation. They are often used in the treatment of lichen planus of the nails. Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be applied directly to the affected nail. They are often used in conjunction with topical corticosteroids to enhance their effectiveness.
  3. Systemic corticosteroids: Systemic corticosteroids are drugs that are taken orally or intravenously. They are used in severe cases of lichen planus of the nails, where topical treatments are not effective. Systemic corticosteroids work by suppressing the immune system and reducing the inflammation that is causing the symptoms. They can be effective in treating lichen planus of the nails, but they are associated with many side effects, including weight gain, high blood pressure, and increased risk of infection.
  4. Cyclosporine: Cyclosporine is an immunosuppressive drug that is used to treat autoimmune diseases, including lichen planus of the nails. It works by suppressing the immune system and reducing the inflammation that is causing the symptoms. Cyclosporine is usually given orally and is often used in severe cases of lichen planus of the nails, where other treatments are not effective.
  5. Methotrexate: Methotrexate is a drug that is used to treat autoimmune diseases, including lichen planus of the nails. It works by suppressing the immune system and reducing the inflammation that is causing the symptoms. Methotrexate is usually given orally and is often used in severe cases of lichen planus of the nails, where other treatments are not effective.
  6. Nail care: Nail care is an important aspect of the treatment of lichen planus of the nails. The nails should be kept clean and moisturized to prevent further damage. Regular nail care can help to reduce the symptoms of lichen planus of the nails and improve the appearance of the nails.
  7. Laser therapy: Laser therapy is a treatment that uses light energy to treat lichen planus of the nails. The laser energy is directed at the affected nail and works by reducing the inflammation and promoting healing. Laser therapy is often used in conjunction with other treatments, such as topical corticosteroids, to enhance their effectiveness.
  8. Nail surgery: Nail surgery is a procedure that involves removing the affected nail and replacing it with a new nail. Nail surgery is often used in severe cases of lichen planus of the nails, where other treatments are not effective. The new nail is usually grown from a skin graft taken from another part of the body.
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