Background: Nail involvement in lichen striatus (LS) is uncommon and has always been reported in association with typical skin lesions. Objective: We attempted to characterize the clinical and pathologic features and the long- term prognosis of nail LS. Methods: Five cases of LS of the nail including three cases with exclusive nail involvement were evaluated and the literature reviewed. Results: Biopsy specimens showed a moderately dense bandlike lymphohistiocytic infiltrate affecting the proximal nailfold, the nail bed, and the nail matrix dermis. Exocytosis with slight spongiosis, focal hypergranulosis, and dyskeratotic cells were detectable in the nail matrix epithelium. Spontaneous regression of the onychodystrophy occurred after 4 to 12 months from the time of diagnosis (mean, 8.4 months). Conclusion: Nail LS is not necessarily associated with skin lesions but can also be an isolated finding. The diagnosis of nail LS should be strongly suspected when a child or a young patient presents with lichen planus-like nail abnormalities localized to the lateral or medial portion of a single nail.
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