Parmentier Laurent, Dürr Caroline, Vassella Erik, Beltraminelli Helmut, Borradori Luca, Haneke Eckart
Department of Dermatology, Inselspital, Berne University Hospital, CH-3010-Bern, Switzerland.
Arch Dermatol. 2010 Nov;146(11):1287-91. doi: 10.1001/archdermatol.2010.325.
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.
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.
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.
皮肤T细胞淋巴瘤可伴有具有临床意义的指甲改变，其表现形式多样且具有误导性。迄今为止，仅有少数报告证实甲床存在直接的特异性肿瘤浸润，而对于局部治疗的疗效知之甚少。
我们描述了一名93岁患有 Sézary 综合征的男性患者出现具有临床意义的指甲改变的病例。光学显微镜研究和T细胞受体重排分析表明甲床内存在特异性淋巴细胞浸润。该患者接受了多次局部氮芥治疗，皮肤和指甲改变均持续完全缓解。
所有皮肤T细胞淋巴瘤患者均应认识到并考虑到特异性指甲受累情况。对于特异性指甲改变的病例，局部氮芥仍然是一种有吸引力的治疗选择，特别是在不适合或不太可能耐受全身治疗的情况下。
