Lichen striatus is a benign, self-limiting inflammatory dermatosis that predominantly affects children. Nail involvement is uncommon and may present as longitudinal ridging, fissuring or splitting.

Case Presentation

A 24-year-old female with a one-year history of vertical nail plate splitting, followed by the development of skin-coloured, scaly papules arranged linearly over the left ring finger. Based on the characteristic clinical presentation, a diagnosis of lichen striatus with nail involvement was made. The patient received topical clobetasol propionate cream five days per week for 30 days, followed by topical tacrolimus 0.1% for three months. The papular eruption subsided within one month, and complete nail growth was observed over 6 months, with resolution of the splitting.

Discussion

The characteristic linear distribution of the papules and the associated nail changes supported lichen striatus, although lichen planus was a close differential. Nail recovery is generally slower than resolution of the skin eruption because the damaged portion of the nail plate must grow out and be replaced by newly formed nail. The improvement following topical clobetasol and tacrolimus is consistent with the use of anti-inflammatory treatment in literature of nail lichen striatus. However, because lichen striatus can resolve spontaneously, a single uncontrolled doesn’t establish that treatment alone caused the recovery. The observed outcome should therefore be interpreted as a favourable clinical association rather than proof of treatment efficacy.

Conclusion

It is important to examine the skin and nails together when evaluating persistent localized nail dystrophy. A linear eruption of skin-coloured, scaly papules provided an important clue to the clinical diagnosis of lichen striatus with nail involvement.