Isolated nail lichen planus: An expert consensus on treatment of the classical form

Abstract

Lichen planus is a benign inflammatory disorder of unknown etiology that may affect the skin, mucosae, scalp, and nails. When the nails are affected, it may lead to permanent destruction with severe functional and psychosocial consequences. Therefore, prompt diagnosis and early treatment are essential, even in mild cases. There are currently no guidelines for the management of nail lichen planus and the published literature on treatment is limited. The aim of this review is to provide practical management recommendations for the classical form of nail lichen planus, especially when restricted to the nails. Topical treatment has poor short-term efficacy and may cause long-term side effects. Instead, intralesional and intramuscular triamcinolone acetonide should be considered first-line therapies. Oral retinoids are second-line choices, and immunosuppressive agents may also be considered.

Keywords: acitretin; alitretinoin; consensus; guidelines; intralesional steroid injections; lichen planus; management; nail dystrophy; nail fissuring; nail lichen planus; nail ridging; retinoids; treatment; triamcinolone acetonide.