title: Specific nail alterations in cutaneous T-cell lymphoma: successful treatment with topical mechlorethamine.
abstract: BACKGROUND
  Cutaneous T-cell lymphoma can be associated with clinically significant nail alterations, the presentation of which can be protean and misleading. To date, only a few reports have demonstrated direct specific tumor infiltration of the nail bed, while little is known about the efficacy of topical treatments.
  
  
  METHODS
  We describe the case of a 93-year-old man presenting with Sézary syndrome who developed clinically significant nail alterations. Light microscopy studies and T-cell receptor rearrangement analysis demonstrated the presence of a specific lymphocytic infiltrate within the nail bed. The patient was given repeated courses of topical mechlorethamine, leading to a sustained complete remission of both skin and nail alterations.
  
  
  CONCLUSIONS
  Specific nail involvement should be recognized and considered in all patients with cutaneous T-cell lymphomas. Topical mechlorethamine remains an attractive therapeutic option in cases of specific nail alterations, especially for situations in which systemic therapies are either not indicated or unlikely to be well tolerated.
authors.affiliation: Department of Dermatology, Inselspital, Berne University Hospital, CH-3010-Bern, Switzerland. laurent.parmentier@insel.ch
authors.forename: Laurent
authors.initials: L
authors.lastname: Parmentier
authors.forename: Caroline
authors.initials: C
authors.lastname: Dürr
authors.forename: Erik
authors.initials: E
authors.lastname: Vassella
authors.forename: Helmut
authors.initials: H
authors.lastname: Beltraminelli
authors.forename: Luca
authors.initials: L
authors.lastname: Borradori
authors.forename: Eckart
authors.initials: E
authors.lastname: Haneke
mesh_terms: D000287:Administration, Topical; D000369:Aged, 80 and over; D015329:Gene Rearrangement, T-Lymphocyte; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage*; D009260:Nail Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D009262:Nails / Q000378:metabolism / Q000473:pathology; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000032:analysis; D012751:Sezary Syndrome / Q000150:complications* / Q000235:genetics; D012867:Skin / Q000378:metabolism; D012878:Skin Neoplasms / Q000150:complications* / Q000235:genetics
chemical_list: D016692:Receptors, Antigen, T-Cell, gamma-delta; D008466:Mechlorethamine