Nail lichen planus

  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    背景:高达10%的扁平苔藓(LP)患者有指甲受累;关于组织病理学特征的研究仍然很少。然而,指甲活检是诊断标准,特别是对于孤立的指甲LP。
    方法:对45例LP患者的指甲进行了临床评估,并从大多数受累的指甲进行了活检(25个指甲床和20个基质活检)。还进行了临床和组织病理学特征的相关性。
    结果:研究组参与者的平均年龄为36.91±18.27岁,M:F比为1.81:1。最常见的LP临床变异是口服LP(51%),29%的孤立指甲受累。临床上,主要特征是onychorrhexis(92.3%),纵行甲(74.3%),和甲床红斑(54%)。组织病理学,甲基质和床上皮的颗粒症(51.1%),其次是锯齿棘皮病(44.4%)和苔藓样条带(24.4%)。51.1%的活检证实了使用普遍诊断标准的诊断。指甲板的独特磨损,\"以前没有描述过的变化,在33.3%的病例中被注意到。
    结论:指甲LP的组织病理学被认为具有诊断作用;然而,现有的诊断标准不够敏感,需要完善。迄今为止,在很多情况下都没有看到像指甲板磨损这样的特征。
    BACKGROUND: Up to 10% of patients with lichen planus (LP) have nail involvement; still there is a paucity of studies on histopathological features. Nevertheless, nail biopsy is the diagnostic standard, especially for isolated nail LP.
    METHODS: Nails of 45 patients with nail LP were evaluated clinically and biopsies taken from most involved nail (25 nail bed and 20 matrix biopsies). Correlation of clinical and histopathological features was also done.
    RESULTS: The mean age of the study group participants was 36.91 ± 18.27 years with a M:F ratio of 1.81:1. The most common clinical variant of LP seen was oral LP (51%), with isolated nail involvement in 29%. Clinically, major features were onychorrhexis (92.3%), longitudinal melanonychia (74.3%), and nail bed erythema (54%). Histopathologically, hypergranulosis of nail matrix and bed epithelium (51.1%), followed by sawtooth acanthosis (44.4%) and lichenoid band (24.4%) were most common. A diagnosis using prevalent diagnostic criteria was confirmed in 51.1% biopsies. Distinctive \"fraying of nail plate,\" a change not previously described, was noted in 33.3% cases.
    CONCLUSIONS: Histopathology of nail LP has been attributed a diagnostic role; however, existing diagnostic criteria are not sensitive enough and need refinement. Not hitherto described features like fraying of nail plate are seen in a significant number of cases.
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  • 文章类型: English Abstract
    BACKGROUND: Nail lichen planus (NLP) occurs in 10% of patients with disseminated disease but it can also occur in isolation. The outcome of treatment is usually disappointing and data about its long-term prognosis are lacking.
    OBJECTIVE: To study clinical features, response to treatment and follow-up of a series of 20 patients with NLP.
    METHODS: A descriptive study was conducted of 20 patients with histologically confirmed NLP seen at consultations for nail disorders between September 2009 and April 2013.
    RESULTS: The mean age was 35 years (9-56 years) with no gender preponderance. Forty percent of patients were children. Stress was an evident triggering factor in 20% of patients. The mean duration was around 48 months (2 months to 10 years). Only 25% of patients had extra-ungual lesions. All 20 nails were affected in 55% of patients. Nail matrix involvement was observed in 85% of cases and 55% had nail-bed involvement. Twenty-five percent of patients were presenting severe involvement such as pterygium or anonychia. Intramuscular corticosteroids were given to 10 patients. In 80% of patients, the NLP was limited or regressed rapidly from the third injection. The average follow-up was 24 months.
    CONCLUSIONS: Our study highlights the frequency of paediatric forms and of often aesthetically unacceptable nail scarring. Early diagnosis of NLP, notably in children, would allow initiation of adequate treatment that could perhaps limit the risk of such sequelae.
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