Inflammatory nail changes in lichen planus and alopecia area
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Lichen planus (LP) and alopecia areata (AA) are T cell-mediated inflammatory dermatoses of the skin that frequently shows nail changes. The clinical manifestations depend on the involvement of the nail matrix or the nail bed.

As the nail matrix is most frequently affected, the commonest clinical features are thinning, longitudinal ridging and distal splitting of the nail bed. Trachyonychia (surface roughening), onychorrhexis and red lunulae have also been observed. If there is proximal nail-fold involvement, bluish discoloration or pigmentation of the nail can be observed . Linear nail-bed dyschromia has been reported as a distinctive dermoscopic feature of NLP. Dorsal pterygium, the presence of a scarred
midline band originating from the proximal nail fold, indicates late-stage matrix involvement.

Nail-bed involvement manifests as onycholysis, subungual hyperkeratosis, nail-bed atrophy and anonychyia. Complete shedding of nail and erosions are sometimes seen. The severity generally does not correlate with the duration of skin disease.

AA is the most common autoimmune condition affecting the hair. The most common nail manifestation of AA is pitting,
which tends to be smaller, shallower and regularly distributed, with a grid-like pattern on the surface of the nail compared with psoriasis.

Medical treatments can be divided into topical,
intralesional and systemic therapies -
Topical tacrolimus 0.1% ointment BD. Ethyl alcohol spray, ‘talkaesthesia’ and concomitant vibrating devices have been used, as has digital block local anaesthesia.
For those with nail-matrix disease, intralesional triamcinolone can be considered.
Systemic corticosteroids can be considered when > 3 nails are involved, or if there are signs of severe disease. Both oral prednisolone 40 mg/day for 2 weeks followed by 30 mg/day for 2 weeks, and intramuscular triamcinolone acetonide 0.5 mg/kg/ month have shown efficacy.