Nail Lichen Planus: A Comprehensive Review of Clinical Features, Histopathology, and Current Treatment

Nail lichen planus (NLP) is a chronic inflammatory disorder that can lead to irreversible damage, such as pterygium and anonychia. While NLP may initially present with subtle nail matrix changes, its unpredictable course and potential for permanent dystrophy highlight the need for early recognition and timely intervention. However, the evidence guiding NLP management remains limited, with most recommendations based on case reports and retrospective studies. This review summarises the current understanding of NLP, including recent insights into its pathogenesis, epidemiology, clinical features, diagnosis, and therapeutic strategies. Topical treatments alone have limited efficacy due to poor drug penetration and are not recommended as monotherapy. Intralesional corticosteroids remain the mainstay of treatment and should be considered early. Systemic corticosteroids, either via intramuscular injection or oral administration, can be considered in severe NLP, but long-term use may be limited by relapse and adverse effects. Oral retinoids, particularly alitretinoin, offer moderate benefit in mild or early-stage disease. Immunosuppressive agents may be reserved for refractory cases. Notably, while most recent findings regarding the JAK-signal transducer and activator of transcription pathway have emerged from studies on cutaneous or mucosal lichen planus, early reports of successful treatment in NLP using JAK inhibitors offer promising new insights for this challenging condition.