# Nail dystrophy successfully treated with dupilumab in pediatric atopic dermatitis: case series and literature review

## TL;DR

Dupilumab, a biologic drug, successfully treated nail abnormalities in children with atopic dermatitis, offering a new treatment option.

## Contribution

This is the first case series demonstrating dupilumab's efficacy for nail dystrophy in pediatric atopic dermatitis patients.

## Key findings

- Five pediatric patients showed marked improvement in nail dystrophy after 12 weeks of dupilumab treatment.
- Literature review confirmed similar improvements in adult patients with AD-related nail changes.
- Dupilumab appears effective and safe for treating AD-associated nail dystrophy in children.

## Abstract

Atopic dermatitis (AD) is a common chronic, recurrent inflammatory disease, yet its accompanying nail abnormalities have long received insufficient attention. The clinical characteristics, underlying mechanisms, and assessment systems for nail dystrophy in AD remain unclear. AD-associated nail dystrophy can manifest in various forms, including Beau’s lines, nail pitting, koilongchia, trachyonychia, leukonychia, brachyonychia, melanoychia, onychomadesis, onychoschizia, onycholysis, and paronychia. Current treatments face limitations such as slow onset of action and uncertain efficacy with traditional therapies, particularly with limited drug options for the pediatric populations. With the deepening of research into the Th2 inflammatory pathway, biologics such as dupilumab have shown therapeutic potential. Through retrospective analysis, this paper presents the effectiveness and safety of dupilumab in five pediatric AD patients with nail dystrophy under 12 years old. After at least 12 weeks of treatment, their skin lesions and nail dystrophy both showed marked improvement. Additionally, we reviewed four reported cases in the literature of adult AD patients with nail dystrophy who experienced significant improvement in nail changes after dupilumab treatment. These results suggest that dupilumab may be an effective treatment for nail dystrophy in AD. This case series provides the first evidence demonstrating the significant efficacy of dupilumab for nail dystrophy in pediatric AD patients. However, further large-scale prospective studies are still needed to better guide clinical practice.