Nail Lichen Planus in Children ‐ Epidemiology, Pathogenesis, Clinical Presentation, and Treatment

ABSTRACT

Nail lichen planus (NLP) is a chronic inflammatory disorder that, while rare in children compared to adults, represents a significant cause of pediatric nail dystrophy that requires early recognition to prevent permanent scarring and nail loss. The condition typically presents as nail thinning, longitudinal ridging, and distal splitting, though it may also manifest as trachyonychia or rare variants like idiopathic atrophy of the nails. Although its exact cause remains unknown, the pathogenesis is characterized by a cell‐mediated autoimmune response where cytotoxic CD8 + T lymphocytes target the nail matrix and bed, often influenced by genetic predispositions or environmental triggers. Diagnosis is primarily clinical, supported by non‐invasive onychoscopy, as nail biopsies are technically challenging and frequently avoided in the paediatric population. Management aims to control inflammation to prevent permanent damage, with high‐potency topical corticosteroids serving as the first‐line therapy. Intralesional steroid injections and systemic treatments are reserved for more severe or rapidly advancing cases. Topical JAK inhibitors also show potential as a therapeutic option. Despite effective treatment options, high relapse rates after discontinuing steroids remain a challenge in clinical practice.