Dilemma of solitary median onychodystrophy and the saving grace of onychoscopy.

Lichen striatus is long known to be a paediatric disorder of Blaschkoid skin papules, but recently it has been classified along with blaschkitis under Blaschko Linear Acquired Inflammatory Skin Eruption (BLAISE). Isolated nail involvement in lichen striatus is rare and when present, usually limits itself to involving the median or lateral nail, thus giving a hint. But when the median nail is involved, it causes a diagnostic dilemma and can be mistaken for median canaliform dystrophy or nail lichen planus. Although nail unit biopsy can be conclusive in such cases, invasive and scarring techniques in the paediatric population are usually avoided. In such instances, onychoscopy can serve as a great diagnostic alternative. When performed on our patient, findings were consistent with the diagnosis of nail lichen striatus, thus ensuring adequate counselling and appropriate management. Onychoscopy findings of differential diagnoses are also discussed.