Nail Irregularities Presenting in Patients with Cutaneous T-Cell Lymphoma: A Systematic Review of the Literature

Shamir Geller, Tomer Goldsmith, Eli Sprecher, Ilan Goldberg
Dermatology, Tel Aviv Sourasky Medical Center, Israel

Introduction: Irregularities of the nails in patients with cutaneous T-cell lymphoma (CTCL) are frequently overlooked and underreported. Nail abnormalities may be related to the underlying disease, to superimposed infection or to therapy (PUVA, radiotherapy or chemotherapy). Our objective was to systematically review the literature in order to characterize nail changes and their incidences in patients with CTCL.

Methods: A systematic review of the published literature between the years 1989-2019 was performed using Pubmed and Embase databases.

Results: We included 3 retrospective studies that evaluated nail irregularities in patients with Sezary syndrome (SS) reporting nail changes in 43.3% (36/83 patients), 62.5% (15/24) and 100% (19/19) of all studied SS patients. The spectrum of nail changes in SS patients included nail thickening, onychodystrophy, yellow discoloration, subungual hyperkeratosis, onychomadesis, trachyonychia, onycholysis, paronychia and leukonychia. One retrospective study evaluated patients with mycosis fungoides (MF), reporting nail changes in 30% (18/60) of all patients. Longitudinal ridging, nail thickening, nail fragility, and leukonychia were reported as the most common changes seen in MF.

Conclusions: Nail irregularities in patients with MF and SS appear to be heterogeneous and are not uncommon. However, their true incidence has not been well evaluated. Further studies are needed to better understand nail involvement in CTCL and its treatment.