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Clinical characteristics of nail lichen planus and follow-up: A descriptive study of 28 patients

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Clinical characteristics of nail lichen planus and follow-up: A descriptive study of 26 patients

S.Capatas , F.Hali, K.Baline , S.Chiheb

Department of dermatology and venereology –HUC Ibn Rochd  Casablanca

 

INTRODUCTION:

Nail lichen planus (NLP) occurs in 10% of patients with disseminated disease but it can also occur in isolation. The outcome of treatment is usually disappointing and data about its long-term prognosis are lacking.The study aim is to study clinical features, response to treatment and follow-up of a series of 28 patients with NLP.

PATIENTS AND METHODS:

 A descriptive study was conducted of 28 patients with histologically confirmed NLP seen at consultations for nail disorders between September 2009 and August 2016.

 

RESULTS :

The mean age was 31,5  years (8—65 years) with no gender preponderance. Forty three of  patients    were children. Stress was an evident triggering factor in 14% of patients. The mean duration was around 32 months (2months to 10 years). Only 18% of patients had extra-ungual lesions. All 20 nails were affected in 50% of patients. Nail matrix involvement was observed in 71 % of cases (Figure a, b) and 39% had nail-bed involvement. Six  patients (21%) were presenting severe involvement such as pterygium (Figure e,c) or anonychia. Intramuscular corticos-teroids were given to 15 patients. In 43% of patients, the NLP was limited or regressed rapidly from the third injection. The average follow-up was 18 months.

DISCUSSION :

The clinical signs of the NLP are very suggestive but The nail biopsy is essential to confirm the diagnosis, especially before treatment .The nail biopsy was carried out  in all our patients with good patient cooperation,even if  40% of them were children. There is no therapeutic consensus NLP . Different therapeutic modalities are reported [1-2]. Intralesional or systemic steroids are treatments of choice, allowing a total or subtotal lesions [3]. Relapse after remission is However possible. Piraccini et al. [4] reported, on a series of 75 patients, two thirds of favorable responses after 5 to 7 months of treatment with systemic steroids, but with a relapse in 60% of patients, mainly in the first year after treatment. All our patients treated with intramuscular injections of steroids have evolved well, without recurrence after 18 months of average decline.

 Our study highlights the frequency of paediatric forms and of often aesthetically unacceptable nail scarring.

CONCLUSION:

Early diagnosis of NLP, notably in children, would allow initiation of adequate treatment that could perhaps limit the risk of such sequelae.

 BIBLIOGRAPHY :

[1] Evans AV, Roest MA, Fletcher CL, Lister R, Hay RJ. Isolated lichen planus of the toe nails treated with oral prednisolone. Clin Exp Dermatol 2001;26:412—4. [2] Prevost NM, English 3rd JC. Palliative treatment of fingernail lichen planus. J Drugs Dermatol 2007;6:202—4.

[3] Grover C, Bansal S, Nanda S, Reddy BS. Efficacy of triamcinolone acetonide in various acquired nail dystrophies. J Dermatol 2005;32:963—8.

[4] Piraccini BM, Saccani E, Starace M, Balestri R, Tosti A. Nail lichen planus: response to treatment and long-term follow-up. Eur J Dermatol 2010;20:489—96.

 

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