Barcitinib effective in severe nail lichen planus- 1st case report - Lichen planus (LP) is an inflammatory disorder of the skin and mucous membranes. LP of the nails occurs in approximately 10% of patients, commonly involves multiple nails and can lead to scarring of the nail matrix and possible complete loss of the nail plate. Nail lichen planus (NLP) is a notoriously difficult to treat nail disorder with high rates of therapeutic failures or relapses. Recently an article describing use of barcitinib in severe recalcitrant NLP was published in the Journal of American Academy of Dermatology.
A woman in her 60s presented with 1 year history of a severe nail dystrophy of all fingers of both hands. Onychomycosis was ruled out by direct examination as well as results of a culture of nail specimens. Presence of longitudinal ridging and fissuring, distal splitting, and trachyonychia led to a clinical diagnosis of severe NLP. No other cutaneous mucosal involvement was seen in the patient. Patient's NLP had been treated with 5 intramuscular triamcinolone injections (40mg per month) followed by oral acitretin (25mg, daily) for 5months without any improvement. Later methotrexate was administered to the patient which showed some efficacy but was discontinued because of adverse effects, such as fatigue and a lowering of her work capacity. The authors then began treatment with baricitinib 4mg daily which led to substantial improvement in 2months and complete clearance at 6 months.
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Dr. Nandita Mohan
BDS, MDS( Pedodontics and Preventive Dentistry)