In patients with progressive, isolated nail lichen planus refractory to intralesional corticosteroid injections, which oral systemic agents have demonstrated the greatest clinical efficacy in your practice?

Oral JAK inhibitors have good efficacy, including tofacitinib, baricitinib, and upadacitinib, if you're able to get any of these covered. Otherwise, oral low-dose naltrexone (3 mg daily) can also be efficacious in patients.