Two Decades of Nails- A Chronicle of Chronic Lichen Planus

A 36-year-old female teacher presented with chronic nail complaints persisting since 2009, which had gradually worsened over these years. Her chief complaint was discoloration, thickening, splitting, and distortion of nails affecting multiple fingers and toes as well. The right ring finger, bilateral index fingernails, and bilateral thumbnails were severely affected, while the right middle finger and left big toenail were moderately involved. She complained of having yellowish discoloration, subungual hyperkeratosis, and nail plate splitting, with pain on pressure, worse while working in water or handling caustic substances. The condition had been progressing since 2022 and was a source of anxiety and embarrassment for her.

Associated complaints - Oral lichen planus since the past one year, presenting with redness of the lateral tongue and gums, with burning pain aggravated by spicy food. There were no white lacy patches on the buccal mucosa. She had not taken any medication for the oral lesions, also it automatically subsided.

Past medical history - Clinical diagnosis of nail lichen planus in 2009. Initially, she had pus and sticky discharges around the nails (2012–2013), which later subsided. In July 2023, she underwent surgery on the right middle fingernail, but the regrown nail was again distorted, giving no permanent benefit.

Past treatment - She had been using Imograf Forte ointment and Flucort ointment daily since 2012, and received Tricort 10 injections in 2018 and again from October 2022 to April 2023. She had also been on conventional medicines in 2013, 2016, 2018, and 2022, with only temporary relief. In 2009, she had a few skin lichen planus eruptions, which resolved without treatment. At present, she continued with Imograf Forte and Flucort ointments daily.

Physical Generals - Patient took a mixed diet, with cravings for spicy food and leafy vegetables and aversion to peas and eggs. She consumed 3–4 liters of water daily, perspired profusely overall on her body, was thermally hot, and had satisfactory bowel movements. Menstrual history was regular, since menarche at 13 years.

Mental generals - Patient was a bold, confident, expressive, and sociable woman, with a helpful nature. However, she was anxious regarding the long-standing nail deformities.

Family history - Family shows hypothyroidism in her sister and diabetes with hypertension in her paternal grandfather.

Based on all these symptoms and present complaints of a pt, Dr. Shah reviewed her case and prescribed medication based on his 40 years of experience.

Follow-ups

19/10/2023: Patient reported about 10% relief in itching. No further spreading was seen. Nail condition remained unchanged, but disease stability was noted.

15/12/2023: All nail symptoms like discoloration, hyperkeratosis, and splitting were status quo, but there was no further deterioration. With the onset of cold weather, she experienced pain in nails.

10/02/2024: Roughness and splitting of the first toenail increased slightly, though other nails remained stable. Patient revealed she was three months pregnant, which might be one of the reasons for mild aggravation.

09/04/2024: Slight improvement in roughness and thickness of nails was noted. No new nails were affected.

02/06/2024: Nails showed less brittleness and reduced toe thickness, though yellow discoloration persisted. No itching or new spots appeared.

05/11/2024: A relapse occurred with roughness and distortion of the right fingernail due to a four-month treatment gap. Other nails remained better and under control. Pt restarted the homeopathic treatment with Lifeforce.

31/12/2024: The condition was stable. Roughness and distortion of the affected nail persisted, but discoloration showed slight improvement.

25/02/2025: 10–20% improvement in roughness and distortion was noted. Yellow discoloration improved slightly. Other nails continued to remain better.

21/04/2025: Overall 70% improvement observed. Roughness, brittleness, and pain were much less, though discoloration persisted. Patient was very satisfied with the progress.

14/06/2025: Improvement reached 75%. No spread of lesions, no new spots. Brittleness and roughness improved further. Yellow discoloration also better.

In recent follow-up on 05/08/2025: Overall 75–80% improvement was noted. No relapse, no new eruptions. Old spots improved with nails becoming much healthier, smoother, and stronger.

Conclusion:

This case depicts the chronic and relapsing course of nail lichen planus, which showed limited response to steroids. With consistent homeopathic management with Lifeforce, the patient achieved gradual but sustained improvement in nail texture, roughness, and discoloration, with overall 75–80% recovery and marked improvement.

Case study written by Dr. Shreya Hedaoo, an associate Doctor to Dr. Rajesh Shah, MD [Homo].