Nail & Skin Disorders

Under the Microscope: Lichen Planus

Lichen planus is an inflammatory skin condition that can affect the nails as well as most other parts of the body.

<p class="NoParagraphStyle">Photo courtesy of Dr. Jere Mammino (</p>

What is it? Lichen planus affects 1%-2% of the general population. It can develop nearly anywhere on the body. On the skin, it appears as rows of itchy, flat-topped bumps. It can also appear on the inside of the cheek and on the gums and tongue. On the scalp, the condition (called lichen planopilaris) can cause permanent damage to hair follicles and leave adults with patches of baldness. Of those affected with the condition, about 10% will have lichen planus on the nails, causing splitting or thinning of the nails. It is difficult to diagnose because it’s easy to confuse with other nail conditions. Another roadblock to a diagnosis is the fact that lichen planus can show up on all the nails and toes, on only the nails or the toes, or on only select nails or toes.

How do you get it? There is little known about the cause of the condition, but all theories include a reaction of the body’s immune system. Some characterize it as an autoimmune disease, meaning the person’s immune system reacts as though the skin and other parts of the body are foreign and starts to attack those parts.

How is it treated? There is no particular treatment for lichen planus of the nails. When lichen planus appears on the skin, two-thirds of patients will suffer for less than a year. Almost all of them will be clear by the second year. However, when lichen planus appears on the nail, it often destroys the matrix. Consequently, even if the lichen planus clears up, the nail will still be damaged. Lichen planus can be itchy, and it can cause inflammation. For these reasons, doctors sometimes prescribe steroids or suggest a cortisone shot at the base of the nail. These treatments don’t cure lichen planus, but they can provide clients relief from the itching or pain. Other recommendations for relief include a tepid soak or an over-the-counter antihistamine or hydrocortisone cream.

What can a tech do? Lichen planus is not contagious and it’s not dangerous, so techs don’t have to fear contracting the condition or spreading it from client to client. If a tech suspects a client has lichen planus, send her to a doctor. There is a risk to using artificial nails on clients with lichen planus because the disease destroys the matrix, which deforms the nail, leaving an uneven nail bed. If the surface isn’t smooth, it’s possible for pockets of air to get trapped under the enhancement. Careful application of a gel or acrylic overlay, which will fill in all the unevenness of the nail, could be used as a temporary beautification for a special event, but the product should not remain on the nail for a significant length of time.

What else? The safest approach for nail techs is to keep the nail natural. Simply shape and buff the nail without adding an enhancement. Even in this, though, techs should use caution. The damaged nail is sort of like a teepee. The outer nail can be gently buffed to smooth out the ridges, but underneath the damaged nail is soft skin. Until the condition has cleared, excessive or aggressive filing can break the delicate skin underneath and cause bleeding. 

Dr. Lisa Hitchins and Dr. Jere Mammino contributed to this article.

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