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Case Reports
. 2025 Aug 4:18:1849-1855.
doi: 10.2147/CCID.S534496. eCollection 2025.

Successful Treatment of Nail Lichen Planus by the Janus Kinase 1 Upadacitinib and Literature Review

Xingyun Zhao #  1 , Jianbo Zhong #  1 , Yanzhen Xu  2 , Yingzhi Luo  1 , Yunmi Qiu  1 , Liming Wu  1 , Ping Yang  1
Affiliations
Case Reports

Successful Treatment of Nail Lichen Planus by the Janus Kinase 1 Upadacitinib and Literature Review

Xingyun Zhao et al. Clin Cosmet Investig Dermatol. .

Abstract

Nail lichen planus (NLP) is a chronic inflammatory condition that can lead to considerable cosmetic and functional impairment. Failure to administer prompt and effective treatment may result in the development of permanent scarring and nail loss. The precise pathogenesis of NLP remains poorly understood, and there is currently an absence of safe and effective treatment options. Although not FDA-approved for the treatment of lichen planus, Janus kinase (JAK) inhibitors have shown considerable promise as therapeutic agents for a variety of dermatoses. This case report describes a patient with NLP who showed improvement after six months of treatment with upadacitinib, a selective JAK1 inhibitor. Changes were assessed using the Nail Lichen Planus Severity Index (NALSI) score. Following medication administration, the total score of the NALSI for the patient's nail involvement decreased from 146 to 37. However, a mild recurrence was observed following the reduction of the medication dosage (NALSI score to 47).

Keywords: NALSI; inflammatory nail disease; janus kinase inhibitors; nail bed atrophy; nail lichen planus; upadacitinib.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Clinical manifestation of twenty nails with varying degrees of thickening and deformation before upadacitinib treatment. The total NALSI score was 146.
Figure 2
Figure 2
The biopsy specimen demonstrates a band of lymphocytic infiltration surrounding the matrix and eponychium, along with focal areas of hyperkeratosis and hypergranulosis.
Figure 3
Figure 3
After 6 months of upadacitinib treatment, the nail plates showed significant improvement. The total NALSI score was 37.
Figure 4
Figure 4
Upadacitinib was reduced to 15 mg every other day for 3 months, with a mild recurrence of the condition in nails. The total NALSI score was 47.
See this image and copyright information in PMC

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References

    1. Grover C, Kharghoria G, Baran R. Nail lichen planus: a review of clinical presentation, diagnosis and therapy. Ann Dermatol Venereol. 2022;149(3):150–164. doi: 10.1016/j.annder.2022.01.010 - DOI - PubMed
    1. Gupta MK, Lipner SR. Review of nail lichen planus: epidemiology, pathogenesis, diagnosis, and treatment. Dermatol Clin. 2021;39(2):221–230. doi: 10.1016/j.det.2020.12.002 - DOI - PubMed
    1. Iorizzo M, Tosti A, Starace M, et al. Isolated nail lichen planus: an expert consensus on treatment of the classical form. J Am Acad Dermatol. 2020;83(6):1717–1723. doi: 10.1016/j.jaad.2020.02.056 - DOI - PubMed
    1. Iorizzo M, Haneke E. Tofacitinib as treatment for nail lichen planus associated with alopecia universalis. JAMA Dermatol. 2021;157(3):352–353. doi: 10.1001/jamadermatol.2020.4555 - DOI - PubMed
    1. Pünchera J, Laffitte E. Treatment of severe nail lichen planus with baricitinib. JAMA Dermatol. 2022;158(1):107–108. doi: 10.1001/jamadermatol.2021.5082 - DOI - PubMed

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