All fingernails are abnormal ranging from mild horizontal lamellar dystropy, longitudinal, v-shaped, u-shaped and w-shaped sulci as shown in images with variable erythema at the edges of abnormalities. Majority of eponychium appeared normal. Lunula and periungual skin no capillary dilatation noted although some had streaky hyperpigmentation. No palmar erythema. Finger pulps, toe nails, scalp and oral mucosa normal. No other skin lesions
Laboratory: Fungal culture negative
Histopathology: Reject biopsy.
Diagnosis: Lichen Planus, Part of connective tissue disease,
Comments: Would appreciate help in diagnosis and suggestion on further investigations and management.
Questions: Am puzzled by how normal and healthy the unaffected parts of nails look. Had never seen such pattern of erythema. Have anyone seen similar abnormality? Is it justifiable to offer patient systemic steroid to prevent further nails damage and scarring without an histologic diagnosis?