A small percentage of patients with lichen planus develop nail involvement. The severity varies. Some children develop only mild thinning or ridging of the nail plate. Others have a severe nail dystrophy, with pterygium formation and complete and permanent nail loss. A case where the nails are destroyed is pictured here. Rarely, there may even be severe lichen planus of the fingernails and toenails without skin involvement. In any case, attempts to treat the severe forms of nail disease in lichen planus are rarely successful.