Nail atrophy

Specialty: Skin.

• atrophic nail dystrophy
• thinning of the nail plate
• partial anonychia

Why it occurs

• Nail lichen planus (severe destructive inflammation directed against the nail matrix that causes thinning, striations and scarring with formation of nail pterygium)
• Severe peripheral vascular insufficiency (chronic ischemia of the extremities that reduces the nutritional supply to the nail matrix)
• Previous severe physical trauma with permanent scar destruction of the proximal nail matrix
• Hereditary epidermolysis bullosa in its dystrophic variants
• Prolonged digital ischemia due to severe and chronic Raynaud's phenomenon.

Initial workup

Physical examination and detailed digital onychoscopy to look for longitudinal striations, clefts, and pterygium. Longitudinal biopsy of the nail matrix (performed by a specialist) under local anesthesia if the clinical diagnosis of lichen planus is doubtful and it is necessary to avoid anonychia (permanent loss of the nail). Arterial Doppler study of the extremities if there is suspicion of ischemia.

Standard management

• Clobetasol propionate 0.05% cream or ointment — applied daily to the proximal nail fold in the initial inflammatory phases of lichen planus
• Triamcinolone acetonide in suspension — intralesional infiltration of 2 to 5 mg/mL into the nail matrix every 4 weeks to stop the destructive progression of nail lichen planus
• Pentoxifylline — oral hemorheological agent useful to improve microcirculation in cases associated with peripheral vascular insufficiency
• Avoid manicures, aggressive permanent manicures and mechanical rubbing of the fold.