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

Abstract

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.

Description of the most severe signs in nail lichen planus: a strategy to contribute to the diagnosis of the severe stage

“…Nail bed dyschromia, nail fold papules, prominent hyponychial vascular structures and lunula variants, such as stippled erythema, homogeneous erythema, flame-shaped lunula, or yellow lunula were not included. [13][14][15][16][17] Studies on Asian and Indian participants showed higher melanonychia frequencies and oral involvement when compared to our study, probably because of the genetic profile of the Brazilian population. [13][14][15][16]18 Characteristics were assessed according to variables without therapeutic response and its importance for an aggressive therapeutic approach.…”

Ultrasound Features of Nail Lichen Planus

“…However, according to some of the publications, there is no consistency in gender predilection. 3,6,[21][22][23][24] The limitations of this study included the low number of cases included in the sample and the performance of a study in a single center and with one operator. Another limitation is the ultrasound threshold that cannot detect abnormalities <0.1 mm at 18 MHz and <0.03 mm at 70 MHz.…”

“…The presence of a slightly higher number of females in our group is in concordance with some previous clinical studies on the topic. However, according to some of the publications, there is no consistency in gender predilection 3,6,21–24 …”

Multiple Clinical Manifestations of Lichenoid Spectrum: A Patient with Frontal Fibrosing Alopecia, Lichen Planus Pigmentosus, and Nail Lichen Planus

“…The limitation of our report is that the nail involvement of LP was not biopsy-proven. However, we performed dermoscopic examination that is a noninvasive and helpful method to reveal subtle findings in nail involvement of LP [10, 12]. We would like to draw attention to the necessity of thorough clinical and dermoscopic examination of the nails in patients with FFA and/or LPP.…”