Xingyun Zhao,1,* Jianbo Zhong,1,* Yanzhen Xu,2 Yingzhi Luo,1 Yunmi Qiu,1 Liming Wu,1 Ping Yang1 

1Department of Dermatology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Pathology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ping Yang, Department of Dermatology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, No. 261, Huansha Road, Hangzhou, Zhejiang, 310006, People’s Republic of China, Tel/Fax +86 13515819369, Email yangping-apple@163.com

Abstract: Nail lichen planus (NLP) is a chronic inflammatory condition that can lead to considerable cosmetic and functional impairment. Failure to administer prompt and effective treatment may result in the development of permanent scarring and nail loss. The precise pathogenesis of NLP remains poorly understood, and there is currently an absence of safe and effective treatment options. Although not FDA-approved for the treatment of lichen planus, Janus kinase (JAK) inhibitors have shown considerable promise as therapeutic agents for a variety of dermatoses. This case report describes a patient with NLP who showed improvement after six months of treatment with upadacitinib, a selective JAK1 inhibitor. Changes were assessed using the Nail Lichen Planus Severity Index (NALSI) score. Following medication administration, the total score of the NALSI for the patient’s nail involvement decreased from 146 to 37. However, a mild recurrence was observed following the reduction of the medication dosage (NALSI score to 47).

Keywords: upadacitinib, nail lichen planus, nail bed atrophy, inflammatory nail disease, janus kinase inhibitors, NALSI