Therapeutic management of nail lichen planus: a systematic review

Nail lichen planus (NLP) is a chronic inflammatory disorder that affects approximately 10% of patients with lichen planus and may lead to permanent nail damage and significant impairment in quality of life. Depending on involvement of the nail matrix and nail bed, clinical manifestations vary and include longitudinal ridging, nail plate thinning, pterygium formation, onycholysis, subungual hyperkeratosis, and, in severe cases, irreversible nail loss. Despite its potential for long-term morbidity, there are no standardized treatment guidelines, no therapies specifically approved for NLP, and no validated outcome measures to assess treatment response. Management is therefore highly variable and largely guided by expert opinion and small observational studies. We conducted a systematic review to evaluate the efficacy and safety of therapies used in the management of nail lichen planus. The review was registered with PROSPERO and conducted in accordance with PRISMA guidelines. PubMed, Embase, and Scopus were searched from database inception through November 2025 for studies reporting treatment outcomes in patients with NLP. Thirty-seven studies comprising 269 patients were included. Intralesional corticosteroids were the most frequently utilized therapy (34.2%), followed by systemic corticosteroids (18.6%), steroid-sparing immunomodulatory agents (16.7%), combination therapies (8.9%), Janus kinase inhibitors (5.2%), oral retinoids (3.4%), topical corticosteroids (2.2%), and laser therapy (0.4%). Overall, therapies were generally well tolerated. Reported adverse events included local injection-related effects with intralesional steroids, systemic corticosteroid-related side effects, hypertension with cyclosporine, and mucocutaneous and laboratory abnormalities with oral retinoids. No adverse events were reported among patients treated with JAK inhibitors, though follow-up durations were limited. This systematic review underscores the heterogeneity of current treatment approaches for nail lichen planus and the critical need for validated outcome measures and well-designed controlled studies to inform evidence-based management strategies and improve patient care.

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