Which of the following diseases is itchy and involves the mucosa and the nails?

Ans: b (Lichen planus) Ref: Pavithran's Textbook of Dermatology p. 29,14Characteristic feature of lichen planus is alopecia, severe itching, oral mucosal and nail involvement.Lichen planusEtiology unknown.Important features are alopecia, severe itching and oral mucosal involvement.Wickham's striae, ie, a network of grayish lines on papules of lichen planus is the characteristic lesion.Important features of the lesion are 5 P's* Pruritic* Purple* Polygonal* Plain top* Papular lesion.Wickham's striae are due to alteration in density of granular layer.It is associated with Kobner phenomenon which is more characteristic of lichen planus than psoriasis.Pterygium of nail (hypertrophy of eponychium) is an important feature and is diagnostic of lichen planus.Histopathological features of typical lichen planus are hyperkeratosis, irregular hypergranulosis, irregular acanthosis, liquefactive degeneration of the basal cells and pointed, saw tooth like elongation of the rete ridges. There is infiltration of dermo-epidermal junction by lymphocytes, histiocytes and melanophages.Minute spaces called "Max Joseph spaces" are seen between the epidermis and dermis due to liquefactive degeneration of the basal cells.Civatte bodies are found which represent necrotic keratinocytes in dermis.Other names are colloid bodies/apoptotic bodies.Immunofluoresence shows bunch of grapes appearance due to IgM on colloid bodies.Associated systemic diseaseHepatitis CAutoimmune diseasesMorphea, lichen sclerosis, alopecia areata, dermatomyositis, myasthenia gravis, vitiligo, ulcerative colitis.Nail changes of lichen planus.Thinning and dorsal splitting of nail platesAnychiaPterygiumLongitudinal groove (onychorrhexis) & roughnessTenting of nail plates.Drugs producing lichen planusCaptopril, gold, beta blockers, NSAIDs