甲扁平苔藓研究进展

Nail lichen planus

甲扁平苔藓临床少见,可伴有皮肤扁平苔藓或独立存在.甲扁平苔藓的流行病学研究较少,其流行病学特点尚未完全阐明.甲扁平苔藓分5型：Ⅰ型为典型皮损伴有甲损害,Ⅱ型为不典型皮损伴有甲损害,Ⅲ型为头皮损害伴有甲损害,Ⅳ型为黏膜损害伴有甲损害,Ⅴ型为单纯甲损害.甲扁平苔藓有许多特征性临床表现,如翼状胬肉.临床上需与甲真菌病及其他可引起甲营养不良的疾病鉴别.甲扁平苔藓的组织病理特征与其他部位的扁平苔藓类似,皮肤镜有助于辅助诊断本病.本病治疗困难,缺少特效治疗方法.系统应用激素是唯一有循证研究支持的疗法.阿维A治疗甲扁平苔藓有效.甲氨蝶呤、环孢素等免疫抑制剂也可有效治疗甲扁平苔藓.甲扁平苔藓预后差,复发率高.

Nail lichen planus （LP）,an uncommon skin disease in clinic,can occur alone or in combination with cutaneous LP.There have been only a few epidemiological studies on nail LP,and its epidemiological features have not yet been clarified.Nail LP can be divided into 5 types：type Ⅰ manifests as typical skin lesions with nail changes,type Ⅱ as atypical skin lesions with nail changes,type Ⅲ as scalp lesions with nail changes,type Ⅳ as mucosal lesions with nail changes,type Ⅴ as nail changes alone.Nail LP has many characteristic clinical manifestations,such as pterygium.In clinic,nail LP should be distinguished from onychomycosis and other diseases that can cause onychodystrophy.The histopathological features of nail LP are similar to those of LP at the other sites,and dermatoscopy can be used for auxiliary diagnosis of nail LP.The treatment of nail LP is difficult,and specific therapies are unavailable.Systemic glucocorticoids are the only evidence-based treatment.Acitretin is effective for the treatment of nail LP,so are immunosuppressive agents,such as methotrexate and cyclosporine.The prognosis of nail LP is poor with frequent recurrence.