Nail Lichen Striatus and Its Differential Diagnoses

Area of Science:

• Dermatology
• Immunology

Background:

• Lichen striatus (LS) is a benign, self-limiting skin condition characterized by linear, band-like rashes following Blaschko lines.
• Its exact cause is unknown but is thought to involve an abnormal immune response to altered keratinocytes.
• While primarily affecting the skin, LS can also impact the nails, though this is often underreported.

Purpose of the Study:

• To highlight the significance of nail involvement in Lichen striatus.
• To emphasize the diagnostic utility of onychoscopy and the role of biopsy in uncertain cases.
• To discuss management options for symptomatic or severe nail LS.

Main Methods:

• Clinical observation and case reviews were utilized.
• Diagnostic criteria for LS, including skin and nail presentations, were analyzed.
• Onychoscopy and nail unit biopsy were considered as diagnostic tools.

Main Results:

• Nail LS, presenting as single nail dystrophy or partial nail involvement, is likely underdiagnosed.
• Onychoscopy can aid in visualizing nail changes and potentially avoid biopsies.
• Nail LS can persist long after skin lesions resolve, requiring management.

Conclusions:

• Suspected nail LS warrants consideration, especially with characteristic skin rashes.
• Onychoscopy is a valuable, non-invasive tool for diagnosing nail LS.
• Biopsy is reserved for cases with diagnostic uncertainty to rule out more severe conditions.