CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders: Autoinflammatory Disorders
This article is part of the Research TopicBiologics and Targeted Therapies for Autoimmune and Auto-inflammatory Dermatoses: Balancing Efficacy with Safety and ToxicityView all 17 articles
Nail dystrophy successfully treated with dupilumab in pediatric atopic dermatitis: Case series and literature review
Provisionally accepted
- University of Electronic Science and Technology of China, Chengdu, China
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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 cases 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.
Keywords: atopic dermatitis, Dupilumab, Nail changes, Nail dystrophy, Onychodystrophy
Received: 17 Jul 2025; Accepted: 30 Jan 2026.
Copyright: © 2026 Wang, Liu, Yang, Liu, Zhou and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiyuan Zhou
Lixia Zhang
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