Lichen planus of the nails may cause permanent nail loss (anonychia) when it affects the nail matrix. This occurs due to which specific histological change at the nail matrix?
- A Fibrotic replacement of nail matrix with synechiae formation (pterygium formation) ✓
- B Subungual hyperkeratosis from epidermal hyperproliferation
- C Leukonychia from parakeratosis of the nail plate
- D Onycholysis from seronegative spondyloarthropathy
Correct answer: A. Fibrotic replacement of nail matrix with synechiae formation (pterygium formation)
Explanation
In lichen planus of the nail matrix, the lichenoid inflammation causes destruction of the nail matrix and subsequent fibrosis, leading to dorsal pterygium — the skin from the proximal nail fold adheres to the scarred nail bed forming a wing-shaped synechia. This may progress to complete anonychia (nail plate loss). Subungual hyperkeratosis, onycholysis, and pitting can occur in various nail disorders, but pterygium with scarring matrix destruction is the pathway to permanent nail loss in nail LP.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.