Dupilumab for Atopic Dermatitis with Twenty-Nail Dystrophy: A Case Report

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.