According to the American Academy of Dermatology, lichen planus affects about 1%-2% of the general population. There is little known as to the cause of the condition, but all theories include a reaction of the body’s immune system. The problem is doctors don’t know what causes the immune system to react. “There is no evidence of outside stimulus,” says Dr. Jere Mammino, D.O., a clinical dermatologist at Advanced Dermatology in Oviedo, Fla. “In a way, lichen planus is an auto-immune condition, because the immune system attacks the skin,” says Mammino. But even in this, lichen planus is an exception. “That term refers to genetic conditions such as rheumatoid arthritis or lupus,” he says. Yet, there is no conclusive evidence that lichen planus is genetic. Lichen planus can develop nearly anywhere on the body. On the skin, lichen planus “appears as rows of itchy, flat -topped bumps,” according to the Mayo Clinic. Lichen planus can also appear on the inside of the cheek and on the gums and tongue. Often a dentist will recognize the white lines and dots that are present in the mouth and send the patient to a dermatologist for diagnosis. Lichen planus also appears on the scalp (referred to as lichen planopilaris). On the scalp, 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, says Dr. Mammino. The condition can cause splitting or thinning of the nails. “It can be very difficult to diagnose,” says Mammino. One reason is it’s easy to confuse with other nail conditions, such as pterygium. 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. There’s no hard and fast rule for how or where lichen planus will appear on the nails. “It really is a diagnosis of exclusion,” says Dr. Lisa Hitchins, a Houston-based board-certified dermatologist. “There is no particular treatment for lichen planus of the nails,” says Hitchins. “There is really not a lot you can do.” When lichen planus appears on the skin, says Hitchins, 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 a hydrocortisone cream. The good news is that 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.[PAGEBREAK]

WHAT’S A TECH TO DO?

If a tech suspects a client has lichen planus, send the client to a doctor. Because lichen planus is so hard to diagnose, educate the client about the condition before her doctor’s visit, and suggest she ask her doctor specifically about the condition. When a tech sees the damage lichen planus can cause to a client’s nails, it’s natural for her to want to make the nails more beautiful by applying an enhancement. Take caution. “There is a risk to using artificial nails on clients with lichen planus,” says Dr. Hitchins. The problem lies in the fact that lichen planus destroys the matrix, which deforms the nail, leaving an uneven nail bed. Because the surface isn’t smooth, it’s possible for pockets of air to get trapped under the enhancement. “Never use a tip,” says Hitchins. A tip can trap air, water, debris, bacteria, and any number of other things, which could eventually promote a fungal infection. “Once fungus has developed on the nail,” says Hitchins, “clients will need to have a prescription for an oral treatment.” 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, suggests Hitchins, but the product should not remain on the nail for a significant length of time. The safest approach for nail techs to take 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,” says Hitchins. “The outer nail can be gently buffed to smooth out the ridges, but underneath the damaged nail is soft skin.” Excessive or aggressive filing can break the delicate skin underneath and cause bleeding. Eventually, lichen planus should clear up, but varying damage to the nail bed and nail plate will remain. It is possible, once the condition has cleared, that techs will be able to safely apply and maintain enhancements on a client whose nails are rough and split due to permanent damage of lichen planus. Assess the nails to confirm the natural nail fully covers the nail bed — so product isn’t applied over unprotected skin — and take special care that the product adheres where the nail remains unsmooth to avoid air getting trapped.