Efficacy of Dupilumab in Treating Trachyonychia and Other Nail Dystrophies: A Systematic Review of Case Reports

Trachyonychia and related nail dystrophies are often associated with inflammatory skin diseases such as atopic dermatitis, psoriasis, and alopecia areata. Management remains difficult, as standard therapies frequently yield limited benefit. Dupilumab, an IL-4Rα antagonist, is effective for Th2-driven conditions, but its role in nail dystrophies has not been systematically assessed. This review evaluates the existing evidence on dupilumab for trachyonychia and related nail disorders. A systematic search of PubMed, Wiley, Web of Science, MEDLINE, Google Scholar, and EBSCO was performed from inception to July 2025 with a string of specified keywords. Studies reporting patients with nail dystrophy treated with dupilumab were included. Two reviewers independently extracted data and assessed study quality using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. Eight case reports met the inclusion criteria. Trachyonychia, twenty-nail dystrophy, median canaliform dystrophy, and mixed onychodystrophies were represented. All reports described clinical improvement, with several achieving near-complete recovery. Time to improvement ranged from weeks to over a year, with pediatric patients often responding faster. Dupilumab was well tolerated, with no serious adverse effects reported. Concurrent therapies limited the attribution of outcomes solely to dupilumab. Current evidence suggests dupilumab may improve nail dystrophies associated with Th2-mediated disease. However, evidence remains limited to isolated case reports. Larger controlled studies using standardized nail outcome measures are needed to confirm efficacy.