Nail Changes in Sézary Syndrome: A Single-Center Study and Review of the Literature

Abstract

Background: The onychodystrophies associated with Sézary syndrome (SzS) have rarely been described in the literature. We performed a retrospective analysis of SzS patients at a single institution and compared our data with previous publications. Objectives: The objectives of this study were to identify and describe the most frequent nail alterations in patients with SzS. Methods: A retrospective analysis was performed with some prospective observations at the University of Pittsburgh from 1989 to 2017. Results: We identified 54 patients with SzS out of 535 patients with cutaneous T-cell lymphoma. Nineteen patients with SzS had photos of their nail. All those patients exhibited some type of onychodystrophy. The most common types were paronychia (63.2%; 12/19), leukonychia (42.1%; 8/19), onycholysis (42.1%; 8/19), trachyonychia (31.6%; 6/19), and subungual hyperkeratosis (26.3; 5/19). Cluster analysis of our data in comparison with published data on the psoriatic nails indicated that while leukonychia, onycholysis, subungual hyperkeratosis, and nail discoloration were frequently observed in psoriasis, onychauxis, anonychia, distal notching, and onychoschizia occurred more commonly in patients with SzS. Conclusions: The most common nail manifestations in SzS patients included paronychia, leukonychia, and onycholysis. The nail manifestations in SzS patients appeared to be heterogeneous, while onychauxis, anonychia, distal notching, and onychoschizia seem to be specific to SzS in comparison with psoriasis.

Nail unit dermoscopy (onychoscopy) in the differential diagnosis of erythroderma

“…Onychodystrophy was reported to affect 32%-63% of patients with Sézary syndrome. 5,6 In the current study, longitudinal ridging was more frequently observed in CTCL than in other entities. However, it should be underscored that patients with CTCL were significantly older than participants with psoriasis, AD or PRP.…”

Brentuximab‐induced splinter nail haemorrhages in a patient with Sézary syndrome: A case report

“…In very rare cases in which Sézary syndrome presents with nail haemorrhages, the entire nail plate is usually involved, unlike in this case, where lesions followed a precise sequence that can be traced back to the monthly applications of brentuximab and its direct cytotoxic effects on CD30+ T lymphocytes in the nail matrix 12–14 …”

“…10,11 In very rare cases in which Sézary syndrome presents with nail haemorrhages, the entire nail plate is usually involved, unlike in this case, where lesions followed a precise sequence that can be traced back to the monthly applications of brentuximab and its direct cytotoxic effects on CD30+ T lymphocytes in the nail matrix. [12][13][14] This adverse event caused by brentuximab has not yet been reported in the scientific literature, and we hope that these findings will encourage physicians to pay more attention to nail lesions in patients undergoing treatment for Sézary syndrome.…”

Development of a bioaction complex for the onychodystrophy treatment

“…Moreover, in one patient, onychodystrophy was represented by total onycholysis of the nail plates, and in the other patient, subungual hyperkeratosis imitated psoriasis and the process was resistant for treatment for a long time [9]. Often, damage to the nail plates is a symptom of severe dermatological diseases such as T-cell lymphoma, lupus erythematosus, psoriasis, focal alopecia, lichen planus and may precede the appearance of the main symptoms of the disease [10,11,12,13]. Thus, Prayogo R.L.…”