Chemotherapy and nails

Drug-induced nail changes are mostly transient in nature and (after discontinuation of the medication) regressible. Cytostatics and some immunosuppressants such as methotrexate or azathioprine slow down nail growth. This phenomenon may also occur with lithium, zidovidine, sulfonamides and heparin. In addition to EGFR inhibitors such as erlotinib and cetuximab, taxanes (docetaxel, paclitaxel) and anthracyclines(doxorubicin, daunorubicin) cause side effects on the nails. The so-called PATEO syndrome (periarticular tenar erythema with onycholysis) can occur under taxanes.

Common side effects on nails caused by cytostatic drugs

• Bleomycin: Beau-Reil lines, onycholysis, brownish lunula discolouration
• Busulfan: Hyperpigmentation of the nails;
• Cisplatin: hand-foot syndrome, patchy hyperpigmentation (on pressure points, oral mucosa, nails), leuconychia, Beau-Reil lines
• Cyclophosphamide: hand-foot syndrome, hyperpigmentation (gingiva, palmo-plantar, nails), alopecia
• Cytarabine: hand-foot syndrome, Beau-Reil lines, leuconychia
• Cabozantinib: palmar-plantar erythrodysesthesia
• Dacarbazine: Melanonychia
• Daunorubicin: Beau-Reil lines, Meessian ligaments, onycholysis, melanonychia
• docetaxel/paclitaxel: pseudoscleroderma, Beau-Reil lines, onycholysis, hyperpigmentation
• Doxorubicin: Beau-Reil lines, onycholysis, phototoxicity, hyperpigmentation (face, tongue buccal mucosa, neck, shoulders, hands, feet, nails),
• Fluorouracil: hyperpigmentation (tongue, conjunctiva, nails), onycholysis, scleronychia, irritated actinic keratoses (see below actinic keratoses)
• Gemcitabine: exanthema, stomatitis, pseudoscleroderma, alopecia
• Hydroxyurea: exanthema (lichenoid), hand-foot syndrome, ulcers of the extremities, radiatio-recall, hyperpigmentation (tongue, buccal mucosa, nails), alopecia, onycholysis, phototoxicity
• Methotrexate: hyperpigmentation of the lunulae, Beau-Reil lines, onycholysis
• Taxanes: see below PATEO syndrome
• Vinca alkaloids: Beau-Reil lines, leukonychia

Nursing and prophylactic measures during chemotherapy:

• Gel and plastic nails should be removed.
• Regularly cut nails straight, but not too short. It is even better to shorten the nails with a suitable file.
• Apply cream and massage hands and feet daily with suitable products.
• Avoiding nail polish remover containing acetone. Avoid detergents and other aggressive substances.
• Always wear gloves when gardening and cleaning.
• Wear soft cotton socks and comfortable shoes that are not too tight.
• Do not cut cuticles. The cuticle is already damaged by chemotherapy. The risk of infection is particularly high.
• Regular application of nourishing nail oils makes sense.
• If the nails are discoloured, a coloured nail varnish can also be applied (e.g. from La Roche Posay).
• With doxetaxel, the wearing of iced gloves is recommended during infusion therapy with potentially nail-damaging agents. This will decrease the blood circulation locally. The active substance does not reach the acras.

1. Ferreira O et al. (2010) Docetaxel-induced acral erythema and nail changes distributed to photoexposed areas. Cutan Ocul Toxicol 29:296-299.
2. Pfützner W (2018) Cutaneous drug reactions. In: Plewig G et al. Braun-Falco`s dermatology, venereology and allergology. Springer Reference Medicine, Springer Verlag p 617
3. Scotté F et al. (2008) Matched case-control phase 2 study to evaluate the use of a frozen sock to prevent docetaxel-induced onycholysis and cutaneous toxicity of the foot. Cancer 112:1625-1631.
4. Thai KJ et al. (2020) Treatment of Cabozantinib-Related Palmar-Plantar Erythrodysesthesia With Topical Sildenafil, Diclofenac, and Gabapentin Cream: A Case Report. JCO Oncol Pract 16:135-136.