Lichen Striatus with Nail Involvement in a 6-Year-Old Boy
Nail lichen striatus is rare . There are approximately 30 cases of nail lichen striatus reported in the literature . The condition is likely under-reported and under-recognized partly due to the failure to recognize the nail changes associated with lichen striatus. There is no established treatment of nail lichen striatus. Herein, presented a report of a 6-year-old boy with nail lichen striatus who responded to topical mometasone cream twice a day for three months to the skin lesions and proximal nail fold with resolution of the skin lesions and onychodystrophy.

A 6-year-old boy presented with a 10-month history of an asymptomatic linear eruption on the left index finger which gradually extended to the periungual area with resulting nail changes. His past health was unremarkable. There was no history of trauma for the affected areas. The family history was unremarkable.

Physical examination revealed multiple tiny skin-colored papules along Blaschko lines on the left index finger, mild erythema of the proximal nail fold, and onychodystrophy and subungual hyperkeratosis of the nail . The rest of the physical examination was normal. Based on the characteristic physical findings, a diagnosis of nail lichen striatus was made. The child was treated with topical mometasone cream twice a day for three months over the skin lesions and liberal use of emollients. The skin lesions resolved in three months. At one-year follow-up, no onychodystrophy was noted . According to the parents, the nail lesions had resolved four months prior to the one-year scheduled follow-up.

Thus far, there is no established treatment of nail lichen striatus. This case serves as an example that the nail lichen striatus can be successfully treated with a topical corticosteroid. Because of its rarity, nail lichen striatus is often under-recognized. Physicians should be familiar with the nail involvement of lichen striatus so that an accurate diagnosis can be made and unnecessary investigations and inappropriate treatment avoided.