Ji Li,1 Duo Zhang,1 Shuying Dong,1 Lili Zhu,2 Xiaodong Li,1,* Yang Han1,* 

1Department of Dermatology, Affiliated Central Hospital of Shenyang Medical College, Shenyang, Liaoning, People’s Republic of China; 2Department of Dermatology, The People’s Hospital of Liaoning Province, Shenyang, Liaoning, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiaodong Li; Yang Han, Department of Dermatology, Affiliated Central Hospital of Shenyang Medical College, Shenyang, Liaoning, People’s Republic of China, Email lilicmu@163.com; wyh6128543@126.com

Abstract: Atopic dermatitis (AD) typically presents with cutaneous symptoms, but nail changes, particularly twenty-nail dystrophy (TND), are often overlooked. We report a case of a 40-year-old woman with a 3-year history of eczematous erythema and pruritus around the nails, accompanied by nail deformities. She had elevated serum IgE levels (2250 IU/mL) and dermatoscopic findings of thickened yellowish nails with splinter hemorrhages. Diagnosed with AD and TND, she received dupilumab after failing conventional treatments. Within 2 weeks, she experienced significant itch relief, and by 5 months, nearly complete nail recovery was observed, with serum IgE levels decreasing to 823 IU/mL. This case highlights the importance of recognizing nail involvement in AD, suggesting that periungual eczema and TND may represent a distinct phenotype. Dupilumab shows promise as an effective treatment for this condition, warranting further research.

Keywords: atopic dermatitis, twenty-nail dystrophy, dupilumab, nail dystrophy, onychodystrophy