Lichen Planus Limited to the Nails. Presented by C. F. Burgoon, Jr., MD, and R. M. Kostrzewa, MD.
A 58-year-old white department store saleswoman complained of discoloration, thickening, and accumulation of "crumbly" material beneath the first toenails, bilaterally, which had appeared in 1964. Examination in October 1966 revealed separation of the yellowish-colored nail plate of the first toes from the nail bed by abundant subungual keratotic debris. Direct microscopic examination and culture did not demonstrate a dermatophyte. A chiropodist evulsed the first, second, and third toenails of both feet and gave griseofulvin for four months. Within several months, the fingernails became deformed (Figure).Examination showed thickening of all the fingernails with longitudinal striations and a spoon shape. The paronychial area of both first toes was erythematous, the nail plates were absent, and the nail bed was covered with keratotic debris. The left fourth toenail was normal but the toenails of
PHILADELPHIA DERMATOLOGICAL SOCIETY. Arch Dermatol. 1969;100(3):371-373. doi:10.1001/archderm.1969.01610270113023