Lichen Planus of Nails: Causes, Symptoms, and Treatment

Lichen planus can affect nails in about 10 percent of the cases. Nail involvement in LP in isolation is uncommon and has always been associated with typical skin lesions. Rarely, nail lichen planus may occur in the absence of skin, oral, or genital lesions.

The majority of nail change results from damage to the nail matrix or nail root. Nail changes can occur with or without skin involvement. The nails, when affected, tend to become deformed. Commonly, only two or three fingernails or toenails are involved. Occasionally all the nails could be affected.

Signs of Nail Lichen Planus:

Nail changes associated with Lichen Planus include:

• Longitudinal ridging and grooving,
• Pitting, 
• Nail thinning,
• The nail becomes fragile and there may be a loss of nails
• Brown discoloration,
• Depressions of the nail plate,
• Inflammation of the proximal nail folds becomes erythematous.
• The skin of the fingertips shows a honeycomb appearance due to multiple, small, punctuate, and hyperkeratotic depressions.

In severe cases, the nail may be temporarily or permanently destroyed. Lichen planus on the nails causes the nails to become extremely brittle and more prone to cracks and splits.

Symptoms of Nail Lichen Planus:

• There may be no symptoms at all
• Itching
• Stinging sensation
• Burning and pain in the fingertips

Differential Diagnosis:

• Punctuate keratoderma
• Allergic contact dermatitis
• Psoriasis and psoriatic arthritis
• Onychomycosis or fungus of nails
• Lichen nitidus
• Twenty-nail dystrophy
• Secondary syphilis

Diagnosis:

To confirm the diagnosis, biopsy is required. An associated history of lichen planus on the skin may help to make the diagnosis.

Treatment for Nail Lichen Planus:

Homeopathic medicines are beneficial in the cases of Lichen Planus in the nails. The cracks in the nails heal and the brittleness improves. The discoloration goes away and the nails improve and normalize. (In our experience, the Lichen Planus of the skin improves first and the nails improve later.) One can expect excellent improvement with homeopathy. It must be noted that the Lichen planus of nails is more difficult to treat than one on the skin.

Related Conditions: Onychomycosis or fungus of nails

Case studies of Lichen Planus on Nails

Written & Approved by-

Dr. Rajesh Shah

M.D. (Hom.)