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Alopecia Areata Nails — SCE Dermatology MCQ

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HardNail DisordersAlopecia Areata NailsSCE Dermatology

A patient develops rapid thinning, longitudinal ridging and early dorsal pterygium of several nails with violaceous oral plaques. Which management principle matters most?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Treat suspected nail lichen planus early to reduce permanent matrix scarring

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

B is correct. Nail lichen planus can inflame and permanently scar the nail matrix, producing thinning, longitudinal ridging, fissuring and dorsal pterygium. Progressive multi-nail disease therefore needs early dermatology assessment and active anti-inflammatory treatment, often systemic when the matrix is threatened. Waiting for generalized involvement risks irreversible anonychia. Pterygium reflects scarring rather than fungal invasion, and nail avulsion can worsen damage without controlling the inflammatory process. Oral, scalp and genital involvement should be sought because they influence treatment and surveillance.

Reference: British Association of Dermatologists: lichen planus: https://www.bad.org.uk/pils/lichen-planus