Nail Abnormalities Common in Severe Atopic Dermatitis, Study Finds
Nail abnormalities may be highly prevalent among adults with severe atopic dermatitis (AD) and appear closely associated with disease severity, according to findings from a single-center cross-sectional study.
Although AD is typically evaluated through cutaneous inflammation, pruritus, and lesion distribution, nail involvement remains less consistently assessed. Investigators noted that nail disease in AD is “an underrecognized and understudied manifestation,” despite its potential contribution to overall disease burden.
The study included 47 adults with severe AD, defined as an Eczema Area and Severity Index (EASI) score greater than 21. All participants were diagnosed according to Hanifin and Rajka criteria. Researchers collected demographic, clinical, and laboratory data and examined hand nails for abnormalities.
The cohort included 28 men, with a median age of 37 years. Glossy nails were the most common abnormality, occurring in 94% of participants. Other frequent findings included paronychia in 40% and Beau’s lines in 36%.
Several nail changes were associated with more severe AD. Higher EASI scores were significantly linked to Beau’s lines, onychomadesis, eczema of the nail folds, petechiae, and paronychia after correction for multiple comparisons (P BH < .05).
Correlation analyses also demonstrated notable relationships between specific nail findings. Paronychia showed strong associations with Beau’s lines (R = 0.73), eczema (R = 0.61), and petechiae (R = 0.43).
Using principal component analysis and hierarchical clustering, investigators identified 3 phenotypic subgroups of nail involvement: destructive-type, mild-type, and onychoschisis-type. The destructive-type subgroup was associated with older age and more severe disease, suggesting that nail phenotype may reflect differences in structural damage and AD burden.
According to the authors, “nail abnormalities are highly prevalent in severe AD and closely related to disease severity.” They further concluded that “systematic nail assessment should be incorporated into routine AD evaluation.”
Reference
Hałubiec P, Szepietowski J, Wojas-Pelc A, Jaworek AK. Different clinical phenotypes of nail abnormalities in patients with severe atopic dermatitis: a single-centre cross-sectional study. Postepy Dermatol Alergol. 2026;43(2):172-178. doi:10.5114/ada.2026.160782
