Why does she have mouth sores and fingernail problems?

This 57-year-old female presented for evaluation of mouth sores and fingernail problems of a few months duration. She had been treated with an oral antifungal antibiotic without improvement. 

How would you diagnose her condition?

A. Pemphigus vulgaris

B. Lichen planus.

C. Behcet’s disease.

D. Psoriasis.

E. Candidiasis of the oral mucosa and nails.

(Answer and discussion on next page)

Answer: Lichen planus

This patient had biopsy proven-lichen planus. Lichen planus is a cell-mediated immune response of unknown origin. An association is noted between lichen planus and hepatitis C virus infection.  

Oral lesions may be asymptomatic, have a burning sensation, or they may even be painful if erosions are present, as seen in this case. Nail findings are found in roughly 10% of patients with lichen planus. These findings are most commonly longitudinal grooving and ridging. 

Hyperpigmentation, subungual hyperkeratosis, onycholysis, and longitudinal melanonychia can result from lichen planus. A variety of treatments have anecdotally been suggested—including corticosteroids, cyclosporine, griseofulvin, and sulfasalazine.