Question:
What is the diagnosis in a woman who has scarring alopecia, thinning of nails, and hyperpigmented patches over the leg?
What is the diagnosis in a woman who has scarring alopecia, thinning of nails, and hyperpigmented patches over the leg?
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Lichen planus can affect the scalp (scarring alopecia), nails (thinning/pterygium), and skin (pigmented patches) together.
Updated On: Jul 8, 2026
- Lichen planus
- Psoriasis
- Secondary syphilis
- Dermatophytosis
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The Correct Option is A
Solution and Explanation
Step 1: List the three clinical clues given.
The woman has three findings together: scarring hair loss, thin nails, and dark patches on the legs. Diagnosing the disease means matching one condition that explains hair, nail, and skin changes together.
Step 2: Match hair loss to the diagnosis.
Lichen planopilaris is the form of lichen planus that attacks hair follicles. It destroys the follicle permanently, so the hair loss it causes is scarring, meaning the scalp skin looks smooth and shiny where the follicles used to be, unlike patchy but reversible hair loss in other diseases.
Step 3: Match the nail change.
Lichen planus of the nail causes thinning of the nail plate, longitudinal ridging, and in bad cases a permanent scar called pterygium, where a skin fold grows over the nail bed. Thin nails fit this pattern.
Step 4: Match the skin change on the leg.
A variant called lichen planus pigmentosus produces flat, dark brown to slate colored patches, often on sun exposed or flexural skin including the legs. This explains the hyperpigmented patches.
Step 5: Rule out the other options.
Psoriasis causes nail pitting and thickening, not thinning, and its hair loss is non-scarring. Secondary syphilis gives a diffuse rash with moth-eaten, non-scarring hair loss, not the pattern described here. Dermatophytosis is a fungal skin infection that does not cause scarring alopecia or nail thinning in this pattern.
Final Answer:
The combination of scarring alopecia, nail thinning, and hyperpigmented leg patches points to
\[ \boxed{\text{Lichen planus}} \]
The woman has three findings together: scarring hair loss, thin nails, and dark patches on the legs. Diagnosing the disease means matching one condition that explains hair, nail, and skin changes together.
Step 2: Match hair loss to the diagnosis.
Lichen planopilaris is the form of lichen planus that attacks hair follicles. It destroys the follicle permanently, so the hair loss it causes is scarring, meaning the scalp skin looks smooth and shiny where the follicles used to be, unlike patchy but reversible hair loss in other diseases.
Step 3: Match the nail change.
Lichen planus of the nail causes thinning of the nail plate, longitudinal ridging, and in bad cases a permanent scar called pterygium, where a skin fold grows over the nail bed. Thin nails fit this pattern.
Step 4: Match the skin change on the leg.
A variant called lichen planus pigmentosus produces flat, dark brown to slate colored patches, often on sun exposed or flexural skin including the legs. This explains the hyperpigmented patches.
Step 5: Rule out the other options.
Psoriasis causes nail pitting and thickening, not thinning, and its hair loss is non-scarring. Secondary syphilis gives a diffuse rash with moth-eaten, non-scarring hair loss, not the pattern described here. Dermatophytosis is a fungal skin infection that does not cause scarring alopecia or nail thinning in this pattern.
Final Answer:
The combination of scarring alopecia, nail thinning, and hyperpigmented leg patches points to
\[ \boxed{\text{Lichen planus}} \]
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