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Turner VL, Wortsman X. Ultrasound Features of Nail Lichen Planus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:781-788. [PMID: 38189552 DOI: 10.1002/jum.16410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To describe the ultrasonographic features of nail lichen planus (NLP), which, so far, have not been reported in the literature. METHODS A retrospective single-center study of NLP patients' color Doppler ultrasound examinations was performed between March 2014 and January 2023. Inclusion criteria were patients ≥15 years with a confirmed clinical diagnosis of NLP in sequential order. Exclusion criteria included concomitant systemic or local cutaneous or nail diseases and systemic or local nail treatments before the ultrasound examination. The ultrasound protocol included the examination of all fingernails or toenails following the reported protocol for dermatologic ultrasound examinations at high and ultra-high frequencies. Patient demographics and ultrasound features of the nail bed, periungual region, nail plate, and regional vascularity were registered and analyzed statistically. RESULTS A total of 36 patients met the criteria. All cases presented thickened and decreased echogenicity of the nail bed. A hypoechoic halo surrounding the origin of the nail plate was present in 78% of cases. Exactly 58% of patients presented decreased echogenicity of the proximal periungual dermis, and 86% showed thickening of the periungual dermis. Hypervascularity of the nail bed was seen in 94% of cases. The mean maximum thickness of vessels, the peak systolic velocity of the arterial vessels, and other blood flow findings are provided. CONCLUSION Ultrasonography can support the diagnosis of NLP, which benefits the non-invasive discrimination of nail conditions and can avoid the potential permanent scars derived from nail biopsies. Furthermore, ultrasound may be a powerful tool to monitor this disease's treatment.
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Affiliation(s)
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Ceccarelli MA, Gavilanes-Coloma MC, D'almeida L, Azulay D, Iorizzo M, Starace M, Haneke E, Nakamura RC. Description of the most severe signs in nail lichen planus: a strategy to contribute to the diagnosis of the severe stage. Int J Dermatol 2022; 61:1124-1130. [PMID: 35325468 DOI: 10.1111/ijd.16167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/07/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe nail lichen planus (NLP) does not respond well to treatment and is often poorly considered and described in detail. OBJECTIVE We sought to describe the characteristics of severe NLP. METHODS A retrospective data analysis was performed, including the photographic records of the most compromised nails of patients with NLP over 18 years old, who consulted between 2009 and 2019 at the Instituto de Dermatologia Professor Rubem David Azulay in Rio de Janeiro, Brazil. Descriptive and statistical analysis using Fisher's exact test was performed to verify the hypothesis of independence between characteristics (P < 0.05). RESULTS A total of 102 patients were included. Anonychia was associated with severe thinning of the nail plate, retraction of the nail bed or nail plate, residual nail plate, loss of proximal nail fold limits, and onychoatrophy. Dorsal pterygium was associated with loss of proximal nail fold limits, onychoatrophy, and distal splitting greater than 50%. CONCLUSION We provide descriptions of the most severe signs in order to facilitate the clinical diagnosis when a biopsy is not feasible and suggest an update of current NLP classifications.
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Affiliation(s)
- Miguel A Ceccarelli
- Nail Studies Center, Instituto de Dermatologia Professor Rubem David Azulay, Hospital Geral da Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Nail Diseases Outpatient Clinic, Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ), Rio de Janeiro, RJ, Brazil
| | - Maria C Gavilanes-Coloma
- Nail Studies Center, Instituto de Dermatologia Professor Rubem David Azulay, Hospital Geral da Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luiza D'almeida
- Nail Studies Center, Instituto de Dermatologia Professor Rubem David Azulay, Hospital Geral da Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - David Azulay
- Nail Studies Center, Instituto de Dermatologia Professor Rubem David Azulay, Hospital Geral da Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Michela Starace
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology, Alma Mater Studiorum, Universita` di Bologna, Bologna, Italy
| | - Eckart Haneke
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland.,Dermatology Practice Dermaticum, Freiburg, Germany.,Centro Dermatología Epidermis, Inst CUF, Senhora da Hora, Grande Porto, Portugal.,Department of Dermatology, University Hospital, Ghent, Belgium
| | - Robertha C Nakamura
- Nail Studies Center, Instituto de Dermatologia Professor Rubem David Azulay, Hospital Geral da Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Nail Diseases Outpatient Clinic, Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ), Rio de Janeiro, RJ, Brazil
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Grover C, Kharghoria G, Baran R. Nail lichen planus: A review of clinical presentation, diagnosis and therapy. Ann Dermatol Venereol 2022; 149:150-164. [PMID: 35272870 DOI: 10.1016/j.annder.2022.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/08/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
Lichen planus is a multifaceted disease of complex etiopathogenesis. Nails are involved in up to 10% of patients with lichen planus. Although most cases are mild, serious consequences may occur due to rapid progression of the disease, the high risk of scarring, and the resulting irreversible damage to the nail structure. Permanent damage of at least one nail occurs in approximately 4-12% of patients with nail lichen planus. In this narrative review, we emphasize the pathophysiology of nail lichen planus, the emergent nature of the disease, and the spectrum of different clinical manifestations. Diagnosis of nail disease in general, and of nail lichen planus in particular, is rapidly evolving. This review provides a comprehensive account of the non-invasive and invasive diagnostic techniques and treatment options reported in the literature, with emphasis on the efficacy and safety of the drugs used, the associated evidence, and the factors to be taken into account in planning and providing adequate treatment. The role of aesthetic and camouflage options is also summarized.
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Affiliation(s)
- C Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, 110091 Delhi, India.
| | - G Kharghoria
- Department of Dermatology and STD, All India Institute of Medical Sciences, 110029 Delhi, India
| | - R Baran
- Nail Disease Centre-42, Rue de Serbes, 06400 Cannes, France
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Abstract
Changes in nail color can provide important clues of underlying systemic and skin disease. In particular, white discoloration (leukonychia) has a high prevalence with a wide array of potential relevant causes, from simple manicure habits to life-threatening liver or kidney failure. Therefore, a reliable assessment of the patient with leukonychia is essential. In the past, two classifications for leukonychia have been presented. The morphological classifies the nail according to the distribution of the white lines: total, partial, transversal, and longitudinal leukonychia. Mees’ and Muehrcke’s lines are examples of transversal leukonychia, while Terry’s and Lindsay’s nails are examples of total and partial leukonychia. The anatomical classifies according to the structure responsible for the white color: the nail plate in true leukonychia, the nail bed in apparent leukonychia, and the surface only in pseudoleukonychia. In this review, both morphological and anatomical features have been combined in an algorithm that enables clinicians to approach leukonychia efficiently and effectively.
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Archana S. Unusual Occurrence Of Nail Lichen Planus In A Child And Response To Treatment. Dermatol Ther 2022; 35:e15319. [PMID: 35023605 DOI: 10.1111/dth.15319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Singal Archana
- Department of Dermatology & STD University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, 110095, India
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