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28-Year-Old Male Develops Brittle Nails & Rash on Leg

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

For several months, a 28-year-old man has had changes to his nails, which have also become more brittle. He denies any history of trauma to the nails. When asked if he has any rashes, he lifts his pant leg, as shown here.

What do you suspect?

Choose one to reveal diagnosis and discussion

Lichen planus
Iron deficiency
Beau lines

Answer: Lichen planus

See the full case at Consultant360

Biopsy of a lesion on the patient’s shin confirmed the diagnosis of lichen planus. This condition is associated with nail changes in up to 10% of affected patients. Among the changes seen with lichen planus are roughtextured nails with longitudinal ridging. Corticosteroids— either topical with occlusion or administered by injection—may help resolve these nail changes.

Psoriasis is usually characterized by nail pitting and separation of the nail plate from the nail bed. Beau lines are transverse lines in the nail plate that result from trauma to the cuticle; this patient had no history of trauma. Iron deficiency anemia typically produces spoon-shaped, or concave, nails.