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Nail involvement may occur in 1% to 10% cases of lichen planus (LP) and mostly in the setting of widespread cutaneous disease.1 Longitudinal ridging, thinning, and distal splitting of the nail plate are the most common nail changes in LP.2
A man in his 60s presented with painful swelling of the proximal nail folds, dripping of blood from his fingernails and toenails for the last year, and occasional pus discharge. There was no history of preceding trauma or drug intake.
On physical examination, the proximal nail folds were found to be swollen and showed violaceous discoloration of 7 fingernails and 3 toenails. The index fingernails also demonstrated longitudinal ridging, thinning, and focal fragmentation of the nail plate, while the remaining fingernails and involved toenails showed partial to complete loss of nail plate with oozing of blood resulting in hemorrhagic crusting of the nail beds and folds (Figure 1A). Oral mucosa showed lichenoid plaques on the right angle of mouth, bilateral buccal mucosa, and erosions covered with hemorrhagic crusts on the upper and lower lips. A provisional diagnosis of bullous lichen planus of the nails was made. Laboratory investigations revealed raised liver enzyme levels and positive anti–hepatitis C virus antibody status.
Khullar G, Handa S, De D, Saikia UN. Bullous Lichen Planus of the Nails. JAMA Dermatol. 2015;151(6):674–675. doi:10.1001/jamadermatol.2014.5701
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