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Inflammatory dermatoses affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Lichen aureus is a localized chronic variant of pigmented purpuric dermatitis mainly affecting the lower extremity. It occurs as one or a few plaques that are composed of densely aggregated flat papules of an orange, red, or rust color.159 Involvement of the proximal nail folds of fingers and toes was described.160
Therapeutic strategies for pigmented purpuric dermatoses: a systematic literature review
Published in Journal of Dermatological Treatment, 2018
Kerasia-Maria Plachouri, Vaia Florou, Sophia Georgiou
As far as topical treatment is concerned, the use of local steroids in order to reduce pruritus is often applied. Depending on the steroid potency, a use of several weeks is usually recommended (9,11–12). No standardized recommendations can be made in regards to the exact type of local steroid that can be used, since application of various products has been described in the literature, without clear benefit of one specific steroid over others (9,11–12). Reports describing partial clearance of lesions after local application of 0.05% clobetasol propionate without cutaneous atrophy are present in the literature (13–14). Documented regression of PPD lesions has also been reported under a regimen of 0.1% methylprednisolone aceponate ointment daily over 4 to 7 months (15), as well as under treatment with fluocinolone acetonide (16). Even though they can lead to a relief of pruritus, local steroids do not always bring the desired therapeutic outcome (17–18). Furthermore, the risk of steroid-induced skin atrophy should be taken into consideration. In addition to these local treatments, the application of emollients and moisturizers is also encouraged (5), as well as the application of compression stockings, for underlying venous insufficiency which could lead to venous stasis and extravasation (12). There are also reports where a satisfying therapeutic outcome under with local calcineurin-inhibitors was documented (14), although this mostly applies to the variant of lichen aureus. Murota et al. documented an improvement of the skin lesions after 3 months of continuous application of tacrolimus ointment, while 12 months of treatment were necessary for complete resolution of the lesions (14). Boehm et al. described complete resolution of lichen aureus lesions after just 10 weeks of therapy with topical 1% pimecrolimus cream (19). Since calcineurin-inhibitors are not associated with skin atrophy, they are a good alternative for local therapy in contrast to high-potent local steroids (19).