What should you know about lichen sclerosus nails?

Lichen sclerosus is an inflammatory skin condition. It can cause pale, fragile, itchy or sore skin, most often around the vulva and anus. Nail problems such as splitting, ridging, thickening, discolouration or lifting can have many explanations, including injury, infection, eczema or another inflammatory condition. A nail change does not by itself confirm lichen sclerosus. A clinician may examine the nails and affected skin together and may arrange testing if infection or another diagnosis needs checking.

Vulval symptoms can include itching, soreness, pain during sex and visible changes in skin colour or texture. Scratching and friction may create cracks, which can make everyday washing or sexual activity uncomfortable. Treatment aims to calm inflammation and protect the skin; it does not mean every nail change will respond to the same medicine.

Arrange an appointment if a nail is changing, especially when several nails are involved or the change is persistent. Note when it began, whether it follows an injury, and whether there is pain, swelling, discharge or a change in the surrounding skin. Keep nails trimmed, avoid picking or biting, and use gloves for wet work or cleaning. Choose gentle, fragrance-free products and avoid harsh nail treatments until the cause is clearer.

If lichen sclerosus has already been diagnosed, use the prescribed topical treatment exactly as directed and attend follow-up visits. Topical corticosteroids are commonly used to settle inflammation on affected skin. Do not apply a medicine to the nail or genital area unless the prescriber has told you where and how to use it.

Seek prompt medical advice for a rapidly changing nail, increasing redness or swelling, pus, severe pain, bleeding, a new sore that does not heal, or a dark streak that is spreading. Arrange review for persistent vulval itching, pain, white patches, cracks or pain during sex, because these symptoms need an examination and an individual treatment plan.

Could the nail change be caused by infection, injury or another skin condition? Do the genital skin findings fit lichen sclerosus? Should I have a nail sample or skin biopsy? Which products and treatments are safe for my skin? How often should my skin be reviewed?