Nail Changes in Chilblains Mimicking Lichen Planus

The document describes two patients with chilblains who developed severe nail changes that resembled lichen planus, a condition that can affect skin, hair, nails, and mucous membranes. The first patient, a 29-year-old woman, experienced discoloration, blistering, and eventual loss of nails with seasonal changes, leading to complete anonychia (loss of nails). The second patient, a 22-year-old man, had thinning and shedding of nails, also with seasonal variation, and skin symptoms on cold exposure. Both patients had low body mass indices and no history of smoking, drug exposure, or connective tissue diseases. Despite initial suspicions of nail lichen planus, histopathology and clinical correlation indicated that the nail changes were related to severe chilblains. Treatment with cold protection and oral nifedipine led to improvement in chilblains but the nail conditions persisted after 2 years. The document suggests that chronic vasoconstriction and nail matrix ischemia due to chilblains may cause these nail changes, which are severe, cosmetically troubling, and potentially permanent, unlike most cases of chilblains that resolve without disfiguring effects.