Lichen planus on the toenails: what to know

Nail lichen planus may affect one or several toenails. The plate can become ridged, rough, thin, cracked, or partly separated from the nail bed. The skin around the nail may be inflamed, and the nail fold or cuticle can change. Fungal infection, injury, footwear pressure, and other nail conditions can look alike. A clinician may examine the nail closely and test a clipping before choosing treatment.

Keep nails trimmed straight across without digging into the corners, wear roomy footwear, and avoid picking, buffing, or applying cosmetic products to a sore nail. Keep feet clean and dry, and do not share clippers. Depending on the findings, treatment may include a prescribed topical corticosteroid or oral corticosteroid treatment. Nail growth is slow, so improvement may be seen first at the base as new nail emerges.

Arrange a review for persistent ridging, splitting, pain, colour change, or nail lifting. Seek prompt care for pus, spreading redness, marked swelling, or difficulty walking. A rapidly changing single nail should also be examined rather than attributed to lichen planus without testing.

Ask whether testing for fungus or trauma is needed, whether the nail matrix is involved, and what outcome treatment can realistically support. Ask how to apply medicine safely around the nail, how to prevent pressure from footwear, and when the nail should be checked again.