Teenage male with lichen planus of thumbnail and penis.
Central thickening of all fingernails in child with lichen planus.
CLINICAL FEATURES
In the child with lichen planus, the fingernails may show central thickening and pterygium formation. In severe lichen planus, all twenty nails may be involved and loss of nails seen. To distinguish from psoriasis and trachyonychia, the central nail ridging is useful as are the purple pruritic plaques and papules and lacy thickening of the buccal mucosa. In some children, nail findings precede cutaneous and mucosal findings. Ten percent of children diagnosed with twenty nail dystrophy may instead have lichen planus.
TREATMENT
There are no comparative studies on treating lichen planus nails. Reports of improvement with potent topical steroids and topical retinoids such as tazarotene are promising.
