Lichen Planus

Lichen planus of the nails usually affects the proximal matrix and undersurface of the proximal nail fold. A dense, band-like lymphocytic infiltrate is seen directly beneath the epidermis or matrix epithelium, respectively. Liquefaction degeneration of basal cells may be pronounced, causing extensive split formation between the dermis and epithelium. The latter tends to thin out and usually develops hypergranulosis. This in turn does not transform into normal nail substance. Involvement of the most proximal matrix is responsible for the frequent loss of nail sheen. With time, the cul-de-sac where the proximal nail plate is located flattens until it completely disappears and overgrows the matrix with loss of nail formation, which is clinically seen as a pterygium dorsale. Particularly in the matrix and proximal nail bed, spongiosis may be seen and even cause tiny spongiotic vesicles. Bullous nail lichen planus has also been observed.

Lichen striatus shows a band-like dense lymphocytic infiltrate of the affected nail portions with hydropic degeneration of basal cells, exocytosis, mild spongiosis, occasional dyskeratoses and granulosis.

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