Lichen planus limited to the nails in childhood: case report and literature review

Although nail abnormalities have been reported to occur in 1% to 10% of patients with lichen planus, in children with lichen planus they are rarely mentioned in the literature. An 11-year-old boy had a two-month history of nail dystrophy affecting all the fingernails and the great toenails. The nail plates showed longitudinal ridging and thinning as well as onycholysis and distal splitting. There were no cutaneous or mucous membrane abnormalities. A nail biopsy specimen showed hyperkeratosis, hypergranulosis, and acanthosis in the ventral portion of the proximal nail fold and in the nail matrix. A band-like lymphocytic infiltrate was present in the superficial dermis, and the basal layer showed vacuolar alterations. A diagnosis of lichen planus was made. Treatment was intramuscular triamcinolone 20 mg once a month for six months. Since 1969 only 13 proved pediatric cases of lichen planus limited to the nails have been reported, including two children with 20-nail dystrophy and four with idiopathic atrophy of the nails.

Atrichia and papular lesions: report of a case

We report a case of atrichia with papular lesions in a 4-year-old girl. The scalp was completely hairless since birth, except for dark, shiny, coarse hair on the frontoparietal region. Eyelashes and eyebrows were sparse. Numerous papular lesions developed on the hairless scalp, cheeks and neck during the second year of life. Teeth and sweating function were normal. The family history was negative. Histologic examination of a papular lesion showed the presence of a keratin-filled cyst in contact with the overlying epidermis. The pathology of the bald scalp showed the presence of tubular epithelial structures devoid of hair bulbs extending from the epidermis to the deep dermis and the superficial hypodermis. Sebaceous and outer root sheath differentiation was evident in most of the tubular structures that also frequently contained small ducts surrounded by two or three layers of flat epithelial cells. The superficial dermis contained horny cysts, similar to those present on the cheeks.