What Is the Main Idea?

Lichen planus is an inflammatory condition that can affect different parts of the body including the nails. It is not dangerous and may also go away on its own without treatment when mild. However, when it is moderately severe or severe, treatment is important to avoid any permanent issues. This blog post is based on the open access article “Successful Treatment of Nail Lichen Planus with a Lacquer Containing Urea, Keratinase, and a Retinoid Molecule: Report of 10 Cases”, published in the journal Case Reports in Dermatology. It discusses lichen planus as a condition and a possible new line of treatment using a medicated nail lacquer.

What Else Can You Learn?

In this blog post, the general condition of lichen planus and possible causes are discussed. The different symptoms, especially for nail lichen planus, and the current treatment procedures are explained in detail.

What Is Lichen Planus?

Lichen planus is an inflammatory health condition that can affect the skin, hair, mucous membranes, and nail. It is a benign and non-contagious condition which means it cannot be passed on by direct or indirect contact. This disease is seen in men and women equally and is rare in the old and very young populations.

On the skin, it is often seen as small, itchy purple rashes or bumps. It mostly occurs on the wrist, arm, back, and ankle. In mucosal membranes of the mouth and genital organs, vagina and penis, it can appear as white patches with painful sores. It may affect the nails, too, causing them to disfigure.

The reason behind lichen planus is not always known. However, a few reasons why it appears include autoimmune issues, hepatitis C infection, reaction to some pigment or metal, and reaction to certain medications like those used to treat high blood pressure, heart disease, malaria, and diabetes.

How Does It Manifest in the Nails?

Nail lichen planus is observed in 10 to 15% of cases of those with lichen planus. In some cases, it could be the only symptom of lichen planus. If not treated, it is one of the few conditions that could lead to permanent nail loss.

The nails can show different abnormalities in morphology. There could be issues of attachment of nail plate, nail plate thinning, changes in nail surface or color, raised vertical lines on the nail, splitting of nail along the length, or excessive skin tissue between nail plate on top and the nail bed (the part of the nail below the nail plate). In advanced stages, it can lead to a condition called dorsal pterygium which causes the skin from the lower end of the nail to grow and fuse with the matrix underneath it and ultimately the nail bed. Nail lichen planus must be treated immediately after diagnosis to avoid permanent disfiguration.

How Is Nail Lichen Planus Diagnosed?

In general, lichen planus is diagnosed by examining the patient for the symptoms. It can be hard to diagnose nail lichen planus because it must be differentiated from other diseases that cause similar symptoms. An additional step to diagnosing this specific condition is to take a sample of tissue (biopsy) from the affected area of the nail and to examine it carefully.

Nail anatomy

Treating Nail Lichen Planus

Lichen planus does not have a specific treatment procedure. The treatment mainly caters to symptomatic relief. Therefore, in patients without symptoms but having been diagnosed with lichen planus, no treatment is given. In the case where the trigger of the condition is identified, for example, a side-effect of medication, then the medication is immediately stopped. However, it might still take 2 to 3 months for symptoms to disappear.

The treatment for lichen planus, in general, could include antihistamines, topical or oral steroids, ointments used for eczema, ultraviolet light treatment, and retinoic acid. For nail lichen planus, specifically, the first line of treatment is topical steroids that are anti-inflammatory. This may be accompanied by topical tacrolimus which are immune suppressors. This is helpful in case the condition has an autoimmune origin. These medications may or may not help reduce the symptoms. Oral medication of steroids is also used in more severe conditions. However, this treatment may also lead to mild to moderate improvement, and there might be side-effects. Oral retinoids, compounds similar to vitamin A, have been shown to be effective against nail lichen planus.

Latest Treatment Option: Medical Nail Lacquer

Since more effective treatments for nail lichen planus are required, a nail lacquer that has a combination of urea, keratinase, and retinoid was tested in a small study. This lacquer was already shown to be effective against other nail conditions which have similar symptoms to nail lichen planus. In the small pilot study, 10 participants were treated with this nail lacquer for 12 weeks with one daily application. Patients with pterygium where nail lichen planus is in the latter stages were not included in the study.

In the 10 patients, 7 different nail symptoms, as discussed earlier, were assessed and scored before and after the treatment. Overall, the symptom score was reduced by 80% in all cases together. The significance could be seen visually, too. Hence, this treatment seems to be promising for mild to moderately severe nail lichen planus. However, the study needs to be improved with the number of patients, a more thorough examination of the condition (with tissue examination), and using a control group to understand whether the condition improved naturally or due to the lacquer.

Visiting the Doctor

It is important for patients having issues with the nail or skin to seek medical help from the doctor, or specifically a dermatologist, immediately. While lichen planus itself is not a dangerous disease, when left unattended, in some cases it may lead to more serious issues like permanent changes in the body.

Lichen planus and when the condition affects the nail can take time to diagnose because of other conditions like it. When visiting the health care practitioner, it will be helpful to talk about all the triggers discussed above, such as medications that you are taking or the possibility of an autoimmune condition. Also, while going over the treatment plan, this new line of treatment with this specific nail lacquer containing urea, keratinase, and retinoid can be discussed with the health care practitioner.

Note: One of the authors of the paper declared that they have relationships with the company that may provide treatment or diagnostic equipment relevant for described medical conditions. It is normal for authors to declare this in case it might be perceived as a conflict of interest. More detail can be found in the Conflict of Interest Statement by visiting the original article page.

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