What Causes Koilonychia?

Lichen Planus

Patients affected by lichen planus may develop koilonychia as a result of their chronic inflammatory skin condition. Lichen planus causes an affected individual to develop a non-infectious, itchy rash on the skin of their legs and arms. This rash is characterized by purple or pink bumps or lesions that are flat on top, small, and have multiple sides to them. Lichen planus most commonly manifests in individuals who have reached at least their third decade of life. Lichen planus can be caused by certain inherited genetic factors, but in most cases, the cause is idiopathic or unknown. Changes in the nails of which include koilonychia have been observed in approximately ten percent of patients affected by this inflammatory skin condition. The immune-mediated inflammation that occurs in individuals affected by lichen planus can cause their nail matrix to become permanently damaged or destroyed. This mechanism can result in the development of many dystrophies of the nails, including twenty-nail dystrophy of childhood and koilonychia.

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