Onychodystrophy associated with dupilumab therapy for atopic dermatitis

Abstract

AD: atopic dermatitis IL: interleukin INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory disorder affecting the skin and is characterized by a type 2 inflammation, including type 2 helper CD4 T cells, interleukin 4 (IL-4), IL-5, and IL-13. Dupilumab is a monoclonal antibody that blocks IL-4 and IL-13 signaling by binding to the IL-4 receptor alpha subunit that is shared by both IL-4 and IL-13 receptors. Treatment of AD by dupilumab has been shown to be efficacious, with long-term benefit. Unique dupilumab-associated side effects in patients with AD have been reported, including conjunctivitis and head and neck dermatitis caused by unknown mechanisms. Nail changes associated with AD are underappreciated despite a similar incidence of nail involvement in other inflammatory disorders, such as lichen planus. It is estimated that about 11% of patients with AD have some nail changes that are likely related to a corresponding inflammation of the nail bed or matrix. There is a paucity of studies that focus on the therapy of eczematous nail changes or nail-specific side effects in response to AD treatment.