Onychomadesis with lichen planus: An under-recognized manifestation

Grover, Chander; Vohra, Suruchi

doi:10.4103/0019-5154.160512

Cited by 7 publications

(7 citation statements)

References 11 publications

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“…Onychomadesis was also uncommonly seen as reported earlier. 19 In contrast to other studies, 9 koilonychia was not observed in any of our patients. Distal nail matrix involvement was seen as lunular changes.…”

Section: Discussioncontrasting

confidence: 99%

“…It was also noted that the percentage of nails showing longitudinal melanonychia was much higher as compared to previous studies because of the predominance of Fitzpatrick skin phototypes IV and V in our study subjects. Onychomadesis was also uncommonly seen as reported earlier 19 . In contrast to other studies, 9 koilonychia was not observed in any of our patients.…”

Section: Discussioncontrasting

confidence: 55%

“…Onychomadesis was also uncommonly seen as reported earlier. 19 In contrast to other studies, 9 The major limitation of our study was the small number of patients included. NLP is not a common nail disease and we need longer study periods to recruit more patients.…”

Section: Discussionmentioning

confidence: 81%

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Histopathological evaluation of nail lichen planus: A cross‐sectional study

et al. 2020

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Introduction: Up to 10% of patients with lichen planus (LP) have nail involvement; still there is a paucity of studies on histopathological features. Nevertheless, nail biopsy is the diagnostic standard, especially for isolated nail LP. Methodology: Nails of 45 patients with nail LP were evaluated clinically and biopsies taken from most involved nail (25 nail bed and 20 matrix biopsies). Correlation of clinical and histopathological features was also done. Results: The mean age of the study group participants was 36.91 ± 18.27 years with a M:F ratio of 1.81:1. The most common clinical variant of LP seen was oral LP (51%), with isolated nail involvement in 29%. Clinically, major features were onychorrhexis (92.3%), longitudinal melanonychia (74.3%), and nail bed erythema (54%). Histopathologically, hypergranulosis of nail matrix and bed epithelium (51.1%), followed by sawtooth acanthosis (44.4%) and lichenoid band (24.4%) were most common. A diagnosis using prevalent diagnostic criteria was confirmed in 51.1% biopsies. Distinctive "fraying of nail plate," a change not previously described, was noted in 33.3% cases. Conclusion: Histopathology of nail LP has been attributed a diagnostic role; however, existing diagnostic criteria are not sensitive enough and need refinement. Not hitherto described features like fraying of nail plate are seen in a significant number of cases. K E Y W O R D S lichen planus, nail bed biopsy, nail lichen planus, nail matrix biopsy 1 | INTRODUCTION Nail involvement can be seen in up to 10% of patients with lichen planus (LP), 1-7 with permanent nail dystrophy or nail loss occurring in approximately 4% of patients. 4 Nail LP is often associated with involvement of other mucocutaneous sites, 8 though isolated nail involvement can be seen in a significant number of cases. The disease affects fingernails more often than toenails, 9 involving two to three fingernails initially. 9 Distinctive clinical variants of nail LP include nail matrix disease, nail bed disease, trachyonychia, idiopathic atrophy of the nails, and bullous-erosive LP. 10-12 Although any part of the nail unit 4,13 can be involved, the matrix is preferentially involved. 14 Nail bed involvement has been reported to be more common in toenails as compared to fingernails. On the other hand, matrix involvement is more commonly seen in fingernails. 8,13 LP of nail matrix is a slowly progressive but potentially scarring disease, dreaded complications being permanent anonychia and pterygium formation. Hence, an early diagnosis and appropriate therapy are of utmost importance.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 55%

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Histopathological evaluation of nail lichen planus: A cross‐sectional study

et al. 2020

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“…Onychomadesis is usually a late manifestation of the hand, foot and mouth disease. This finding was previously described for LP in a case report [17]. We also detected clinically evident onychomadesis in 1 patient.…”

Section: Discussionsupporting

confidence: 90%

Uncovering subtle nail involvement in lichen planus with dermoscopy: a prospective, controlled study

Elmas

2020

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Introduction There are very few studies investigating the dermoscopic aspect of nail involvement in lichen planus and these studies described dermoscopic features of only clinically visible nail involvement in lichen planus. Aim To reveal subtle dermoscopic nail findings in patients with lichen planus. Material and methods The study included 40 patients with lichen planus and 40 healthy volunteers. All fingernails of the patients and healthy volunteers were examined by a handheld dermoscope and the findings detected were recorded. The patients were grouped by age, gender, disease duration and extent of the disease. The statistical analysis was performed using Chi square test. Results 82.5% of the patients and 17.5% of the healthy volunteers showed at least one dermoscopic nail finding. The frequency of multiple splinter haemorrhage ( p < 0.05), multiple leukonychia ( p < 0.05), longitudinal erythronychia ( p < 0.05), prominent hyponychial vascular structures ( p < 0.05) and onycholysis ( p < 0.05) observed in the patients group was statistically significant. The other findings included distal short longitudinal lines, onychorrhexis, solitary splinter haemorrhage and solitary punctate leukonychia and showed no statistically significant differences between the two groups. Conclusions To the best of our knowledge, this is the first study focusing on uncovering subtle nail involvement in lichen planus. The presence of dilated hyponychial vascular structures in lichen planus was first described in the present study. It can be concluded that the frequency of nail involvement in lichen planus is more than known. Dermoscopic imaging of the nails of all patients with lichen planus may help establish early diagnosis and treatment to avoid permanent nail damage.

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“… 4 Infectious diseases, trauma, autoimmune/systemic diseases, and medications may also injure the nail matrix, leading to onychomadesis. 5 , 6 , 7 , 8 Rare cases of idiopathic forms of onychomadesis include familial autosomal dominant inheritance, as well as sporadic genetic mutation. 3 This case illustrates the possible link between CMGT and onychomadesis.…”

Section: Introductionmentioning

confidence: 99%