Dermatoscopy of nail lichen planus

Area of Science:

• Dermatology
• Nail Diseases
• Diagnostic Imaging

Background:

• Nail lichen planus affects 10% of lichen planus patients, potentially causing nail destruction.
• Early diagnosis is crucial due to the aggressive nature of nail lichen planus.
• Histopathology alone is often insufficient for conclusive diagnosis.

Purpose of the Study:

• To describe the dermatoscopic characteristics of nail lichen planus.
• To identify key dermatoscopic findings that aid in early diagnosis.
• To highlight the utility of dermatoscopy in managing nail lichen planus.

Main Methods:

• Analysis of dermatoscopic photographic data from 11 patients with 79 affected nails.
• Inclusion of cases from a specialized nail disease facility.
• Confirmation of dermatoscopic findings with histopathological analysis.

Main Results:

• Nail matrix abnormalities included trachyonychia (40.51%) and pitting (34.18%).
• Nail bed anomalies observed were chromonychia (55.70%), nail fragmentation (50.63%), splinter hemorrhages (35.44%), onycholysis (27.85%), and subungual keratosis (7.59%).
• Longitudinal streaks (82.28%) and anonychia (1.27%) involved the matrix, bed, and perionychial region; paronychia was present in 31.65%.

Conclusions:

• Nail lichen planus is underdiagnosed and has severe consequences.
• Dermatoscopic findings can aid in early diagnostic suspicion.
• Early diagnosis and treatment through dermatoscopy may improve patient prognosis.