Question:hard
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
Show Solution
The Correct Option is A
Solution and Explanation
Step 1: Understanding the Concept:
The question strings together three findings in one patient: hair loss that scars the scalp, nails that have gone thin, and dark patches on the leg skin. We need one disease that touches hair, nail, and skin all at once.
Step 2: Key Formula or Approach:
Lichen planus is known for exactly this kind of multi-site involvement. Its scalp form (lichen planopilaris) scars the follicle, its nail form thins and ridges the nail plate, and its pigmented form leaves dark patches on the skin.
Step 3: Detailed Explanation:
Scarring means the follicle opening is destroyed for good, which is exactly what lichen planopilaris does to scalp hair, unlike alopecia areata or fungal infections where hair can regrow. The nail changes of lichen planus include thinning, grooves running along the nail, and, in severe cases, a wing-like scar called pterygium. Dark, flat patches over the legs match lichen planus pigmentosus, a recognized variant that favors sun exposed and body fold areas. Checking the alternatives: psoriasis thickens and pits nails rather than thinning them, and its scalp hair loss does not scar. Secondary syphilis gives a moth-eaten pattern of hair loss that grows back, not scarring loss. A fungal skin infection stays confined to the skin and does not explain scarred hair or thinned nails.
Step 4: Final Answer:
Only lichen planus ties together scarring alopecia, thin nails, and hyperpigmented leg patches.
\[ \boxed{\text{Lichen planus}} \]
The question strings together three findings in one patient: hair loss that scars the scalp, nails that have gone thin, and dark patches on the leg skin. We need one disease that touches hair, nail, and skin all at once.
Step 2: Key Formula or Approach:
Lichen planus is known for exactly this kind of multi-site involvement. Its scalp form (lichen planopilaris) scars the follicle, its nail form thins and ridges the nail plate, and its pigmented form leaves dark patches on the skin.
Step 3: Detailed Explanation:
Scarring means the follicle opening is destroyed for good, which is exactly what lichen planopilaris does to scalp hair, unlike alopecia areata or fungal infections where hair can regrow. The nail changes of lichen planus include thinning, grooves running along the nail, and, in severe cases, a wing-like scar called pterygium. Dark, flat patches over the legs match lichen planus pigmentosus, a recognized variant that favors sun exposed and body fold areas. Checking the alternatives: psoriasis thickens and pits nails rather than thinning them, and its scalp hair loss does not scar. Secondary syphilis gives a moth-eaten pattern of hair loss that grows back, not scarring loss. A fungal skin infection stays confined to the skin and does not explain scarred hair or thinned nails.
Step 4: Final Answer:
Only lichen planus ties together scarring alopecia, thin nails, and hyperpigmented leg patches.
\[ \boxed{\text{Lichen planus}} \]
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