title: Nail Alterations in Cutaneous T-Cell Lymphoma: A Case Series and Review of Nail Manifestations.
abstract: BACKGROUND
  Cutaneous T-cell lymphoma (CTCL) encompasses a broad range of lymphoproliferative diseases affecting the skin and can be clinically misleading due to its variable presentation. Nail alterations commonly appear in advanced-stage mycosis fungoides and true Sézary syndrome; however, they may be present in any stage of the disease. Although proper recognition of nail involvement in CTCL has both clinical and therapeutic value, specific nail findings have been infrequently described in the current literature.
  
  
  METHODS
  We describe 4 patients with CTCL who presented with clinically significant nail alterations. The most common findings were nail discoloration, thickening, crumbling, onycholysis, and onychomadesis. Other notable findings included splinter hemorrhages, subungual hyperkeratosis, and anonychia.
  The described cases illustrate many of the documented nail findings associated with CTCL and emphasize the variable nature of nail manifestations. The presence of specific nail alterations should increase the clinical suspicion of CTCL - especially in patients with concomitant systemic and/or cutaneous manifestations - and early biopsy specimens should be taken for diagnosis. Nail alterations should also be accurately described and monitored in all patients with biopsy-confirmed CTCL to help identify treatment response and detect disease recurrence.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Bishop
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Wulkan
authors.affiliation: Department of Dermatology, Florida International University, Miami, Fla., USA; Florida Academic Dermatology Center, Larkin Community Hospital, South Miami, Fla., USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Kerdel
authors.affiliation: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: Laila
authors.initials: L
authors.lastname: El-Shabrawi-Caelen
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, USA.
authors.forename: Antonella
authors.initials: A
authors.lastname: Tosti
keywords: Cutaneous T-cell lymphoma; Mycosis fungoides; Nail manifestations; Sézary syndrome