Rough nails with reticulate oral lesions

A 35-year-old male patient presented with dystrophy of all 10 fingernails. The patient had brittle, thin nails with increased longitudinal ridging [Figure 1a] resulting in a rough, opaque appearance for 6 months. The patient had nontender, reticulate white lesions on his bilateral buccal mucosa [Figure 1b]. Based on the characteristic clinical appearance, we made a diagnosis of trachyonychia secondary to nail lichen planus (LP) with oral lichen planus. Trachyonychia is a disorder of the nail matrix seen in 10% of patients with nail LP. While nail LP is most often isolated in these patients, the most common type of LP associated with nail LP is oral LP.^[1] Treatment is often challenging, and treatment options include topical clobetasol propionate, intramatricial triamcinolone, tazarotene gel, systemic retinoids, and cyclosporine.

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Figure 1:

(a) Brittle, thin nails with increased longitudinal ridging resulting in a rough, opaque appearance (b) Reticulate, white lesions over the buccal mucosa.

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