Nail lichen planus treatment safety

ABSTRACT

Lichen planus is a chronic inflammatory disorder that may cause significant nail changes and impair daily life. Nail lichen planus presents a therapeutic challenge, as the condition is progressive, and there is no specific molecular target for drug development. Treatment options, including topical therapies, intralesional injections, systemic therapies, and small molecule inhibitors, are options for nail lichen planus management. However, ensuring the safety of these interventions is crucial. This paper presents a comprehensive analysis of the safety profiles of commonly used and newer therapies for nail lichen planus to aid in informed treatment decisions.

Areas covered

Topical therapies for nail lichen planus (clobetasol propionate, topical tacrolimus, bath-PUVA), intralesional treatment (triamcinolone), and systemic treatment (corticosteroids, retinoids, small molecule inhibitors (jak/stat inhibitors)), TNF-alpha inhibitors (etanercept), systemic immunomodulators (oral calcineurin inhibitors, mycophenolate mophetil), and antimalarials (chloroquine), each with unique safety profiles and considerations. Herein, we discuss common and uncommon adverse events, as well as utilization for special populations, including pregnant and pediatric patients.

KEYWORDS:

• Nail lichen planus
• safety profiles
• topical therapies
• intralesional treatments
• systemic treatment
• TNF-alpha inhibitor
• adverse event
• pediatric population

Article highlights

• Treatment of nail lichen planus is individualized based on number of nails involved, severity, drug safety and efficacy, and patient characteristics.

• Treatment with intralesional kenalog injections are a first-line treatment for nail lichen planus. Associated pain may be alleviated using talkethesia, ethyl chloride, deep-breathing techniques, and vibration devices.

• Systemic therapies such as oral/IM corticosteroids, TNF-alpha inhibitors, and retinoids have good efficacy for nail lichen planus, though their side effect risk profiles require monitoring, with some patients having contraindications.

• Topical and oral JAK inhibitors have shown promising results in lichen planus patients, though more data is needed on their safety and efficacy profiles for nail lichen planus patients.

• Special consideration is needed for use of systemic and topical treatments for nail lichen planus during pregnancy and breastfeeding.

Declaration of interests

SR Lipner has served as a consultant for Ortho-dermatologics, Lilly, BelleTorus Corporation, and Moberg Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.