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Jump to Key Points New study results linked GLP-1 receptor agonists (RAs) to nail disorders, including a fourfold increase in the incidence of onycholysis. Experts agreed that further investigation is needed and advised against raising unnecessary concerns in patient interactions.
The findings were presented on October 1 in a late-breaker session at the European Academy of Dermatology and Venereology (EADV) 2026 Congress in Vienna, by study co-author Bianca Maria Piraccini, MD, PhD, of the Dermatology Unit at the University of Bologna in Bologna, Italy. While noting the novel findings, she acknowledged that more studies are likely needed to establish any potential causation.
“After adjusting for age, sex, country, comorbidities, and so on, we have a higher prevalence of onycholysis in patients undergoing GLP-1 receptor agonist drugs,” Piraccini said. “This is quite unusual, because onycholysis cannot be related to weight loss, because weight loss is commonly associated with nail lesions, which are usually nail plate surface abnormalities,” she said, “so we think it could be really directly related to the drug and this will prompt us to do more and more studies.”
The multinational, cross-sectional study of people with type 2 diabetes and/or obesity included 575 patients taking GLP-1 RAs and 1329 control patients with no exposure to GLP-1 RAs. The GLP-1 RA users had a mean treatment duration of 18.5 months and reported recent weight loss more frequently than the control patients (76.3% vs 47.3%; P < .001). Patients in the study were from France, the US, Brazil, and Mexico.
- GLP-1 RA users had ↑ onycholysis: 39.3% vs 8.7% controls.
- Any nail disorder: 66.3% GLP-1 RA vs 52.8% controls.
- Dyschromia, fragility, ridges/grooves also more common with GLP-1 RAs.
- Association persisted after weight-loss restriction, but attenuated.
- Findings are hypothesis-generating; causality unproven, bias possible.
At least one nail disorder was reported by 66.3% of GLP-1 RA and 52.8% of control patients (P < .001). Onycholysis occurred in 39.3% of GLP-1 RA users and 8.7% of control patients (P < .001). Dyschromia (45.6% vs 17.0%; P < .001), fragility (58.3% vs 51.1%; P < .005), and ridges/grooves (46.8% vs 31.8%; P < .001) were also more prevalent in the GLP-1 RA users than in the control patients.
When the analysis was restricted to patients who had lost weight, the gap between the two groups narrowed but remained significant, Piraccini noted.
When asked to comment on the results, Shari Lipner, MD, PhD, professor of clinical dermatology and director of the Nail Division at Weill Cornell Medical Center in New York City, said that the findings should be interpreted conservatively.
With regard to the nail findings, “I do not think GLP-1 RA treatment should cause concern based on these data alone,” Lipner told Medscape Medical News. “This is a single, unblinded, cross-sectional study whose findings could reflect detection/reporting bias and weight loss-related nutritional effects rather than drug toxicity to the nail…. I would consider this study as hypothesis generating rather than practice changing, and we should be cautious not to generate fear amongst patients.”
As a potential follow-up investigation, Lipner suggested a prospective cohort study with blinded, objective nail assessment; active comparator drugs, such as SGLT2 or DPP-4 inhibitors; and regular nutritional laboratory tests to help separate drug effects from weight loss-related deficiencies.
According to Piraccini, in light of the findings, physicians should consider examining the nails of patients taking GLP-1 RAs.
“When a patient comes in with increased [weight] loss as they are undergoing GLP-1 receptor agonist treatment, don’t forget to look at the nails and ask if [any disorders] were present prior to starting the treatment or if their onset is during treatment,” she said at the meeting.
Lipner, who was not involved in the study, said that a discussion of nail health could be a worthwhile addition to the visit for patients taking GLP-1 RAs, along with hair loss, which is a more well-established dermatological side effect of these drugs.
“When counseling patients, it is reasonable to mention potential nail and hair changes during rapid weight loss and ensure adequate protein and micronutrient intake, since deficiencies could contribute to nail changes,” Lipner advised.
Piraccini reported receiving grant or research support from Eli Lilly and Company and honoraria/consultation fees from Almirall, Cantabria Labs Difa Cooper, Dercos/L’Oréal, Eli Lilly and Company, ISDIN, Legacy Healthcare, Pierre Fabre/Ducray, Giuliani, Olistic, and Pfizer. Lipner reported no relevant disclosures.
Scott Harris has been covering dermatology for more than a decade. He lives near Washington, DC.
