. As a consequence, disfiguring nail damage is common, especially following regimens containing taxanes used for men and women with breast and prostate cancer. The type and severity of damage is variable, but most intravenous regimens can cause ridges in nails, which correspond to the timings of chemotherapy episodes known as ‘Beau’s lines’. More pronounced chemotherapy nail damage leads to discolouration, brittle nails, acute paronychia, onycholysis and sometimes even complete loss of the nail (see adjacent pictures). This damage is often unsightly and contributes to body image issues during chemotherapy
. More serious consequences include pain, which can limit activities of daily living, and secondary infection. This is of particular concern when patients are also neutropenic as the nails could be a source of systemic infection. In addition to the killing of rapidly proliferating nail stem cells, damage is also thought to be due to chemotherapy’s anti-angiogenetic and neurogenically mediated inflammatory properties
. If marked, the nails can separate from the bed causing pain, secondary bacterial and fungal infections considerably increasing damage to the nail
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Firstly it is important to rule out other general and local medical conditions that could effect the health and appearance of nails, then treat or adopted preventative measures appropriately, if possible:
Although strong evidence is lacking attention should be made to the diet – see our nail health page. Before was discovered, a variety of local strategies have been advised to patients during chemotherapy including petroleum based moisturising balms, wearing nail varnish and cooling.
Moisturising balms: Many patient advocacy groups advise massaging moisturising balms into the nail bed, based on assumptions that oiling skin around the cuticles could improve compliance, thus preventing splitting which can be a route for infection and damage the nail bed. Although this seems intuitively beneficial there were no studies to support this practice or advise which balms to use and hence one of the rationale for the study.
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: Following the significant results of the study, the investigational balm, now referred to as has to be regarded as standard of care to prevent nail damage. It is now comercially available, made in a special process which preserves the polyphenol content, and health medicinal properties, of the essential oils1, 2, 3, 4. There were still some patients in the interventional balm arm of the study who suffered from damage. This was seen if patients had preexisting damage where particularly sensitive to the side effects of chemotherapy or had very high doses. In these cases additional measures such as cooling (see below) is still advised.
Nail varnish: Patients are also often advised to wear nail varnish despite the knowledge that nail polish removers dry the nails. Some poeple report this helps but, likewise, there are no published prospective trials to support this practice during chemotherapy, or in an otherwise healthy population.
Cooling the nails: We have previously published a report showing that cooling the nails bed with pots of iced water helps to reduce its severity
Coping With Chemotherapy
Understandably, the practice has never caught on within the confines of a busy chemotherapy unit. Commercially available cooling gloves have now been tested in a number of randomised trials
. They did reduce the severity of nails damage but they are not particularly popular among UK chemotherapy nurses as they may cover the veins of the hands and prevent assessment of the patient’s extremities.Changes to the fingernails and toenails are relatively common side-effects of chemotherapy. Other cancer treatments can cause it too, along with the hair loss and skin changes.
While some of these changes are a mere nuisance or primarily a cosmetic concern, others can cause more serious infections, and/or significant pain and discomfort. Cancer patients are advised to learn as much as they can about their illness and the changes they might expect. This may help to reduce the symptoms.
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Skin and nail changes can typically be taken care of with some advanced preparation for the treatments and special attention to these areas.
Chemotherapy can cause various nail-affecting symptoms. Fingernails are usually affected more than toenails, but they also heal faster, and grow back to normal about six months after the treatment is over.
For patients that are receiving taxane-based treatment, some oncologists recommend using hydrating nail solutions. Numerous studies suggest that the risk of nail loss associated with Taxol chemotherapy drugs can be significantly reduced by using hydrating nail solutions.
Why Are My Nails Changing During Chemotherapy?
Targeted therapies, amongst them especially Tarceva (erlotinib), which is an EGFR inhibitor used for EGFR positive lung cancers, are also a common cause of various nail conditions.
There is a wide range of medications that have been reported to cause nail discoloration, with visible marks and white or dark lines on the nail. Some of those medications are: bleomycin, cyclophosphamide, dacarbazine, daunorubicin, docetaxel, doxorubicin, erlotinib, etoposide, fluorouracil, gefitinib, idarubicin, imatinib, lapatinib, melphalan, paclitaxel, panitumumab, topotecan, and vincristine.
There are a group of medications, known to cause separation of the nail from the nail bed. Among them are: capecitabine, docetaxel, doxorubicin, eribulin, etoposide, ixabepilone, mercaptopurine, methotrexate, mitoxantrone, and paclitaxel.
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Chemotherapy drugs such as cetuximab, docetaxel, eribulin, erlotinib, gefitinib, lapatinib, paclitaxel, and panitumumab can cause an infection of the skin around or under the nail, as one of the most common conditions following chemotherapy.
Some chemotherapy drugs, namely docetaxel, paclitaxel, sorafenib, and sunitinib, can cause bleeding under the nail, as the most common side-effect of these drugs.
The skin around the nails can become red and swollen, due to the use of cetuximab, eribulin, erlotinib, gefitinib, lapatinib, and panitumumab. Some other drugs, namely docetaxel, paclitaxel, can cause complete nail loss. Graft-versus-host disease, one of the possible side-effects of some cancer treatments, such as bone marrow transplantation, can also cause nail loss.
Nail Changes In Patients Undergoing Cancer Chemotherapy
Lines known as Beau s lines could develop on the nails during and after chemotherapy. The lines can appear both as horizontal and vertical. The nails can change color to yellow, and the lines on them can seem light or darker than the rest of the nail.
Koilonychia is a concave, spoon-like shape of the nails, a state that can develop as a side-effect of chemotherapy. This is not the same as clubbing, which is a process associated with lung cancer, when the fingertips permanently take on a spoon-like shape.
Chemicals in chemotherapy can weaken your fingernails and toenails, and make them brittle and fragile. Some patients even experience nail loss, where nails fall off completely after the first couple of rounds of treatment. Luckily, this is not very common. Not all chemotherapy medications are the same; some are more likely to cause nail loss than others. Taxane (Taxol and Taxotere) are known to cause nail loss more often than other kinds of therapy.
Beauty Routines During Chemotherapy
In case that white cell count is reduced due to chemotherapy- a state referred to as induced neutropenia- chances of developing serious infections increase. A particularly painful infection called paronychia can develop in the area surrounding the nail.
PolyBalm contains waxes and oils that are particularly rich in phytochemicals, especially those from the phenolic polyphenols group. These oils and waxes are able to moisturize the skin, preventing dryness, and splitting and cracking of the nail. They also have anti-inflammatory and antioxidant properties. There is a hypothesis, for the PolyBalm trial, that when oils with these properties are applied locally to the nail bed, they act as a local antidote to the chemotherapy, thus preventing damage to the proliferating stem cells.
Additionally, anti-microbial properties of these oils and waxes in PolyBalm can prevent secondary infections, keeping the nail healthy and intact. - see trial results.
Lung Cancer And Nail Clubbing
In case of infection, patients are advised to talk to their oncologists. Some infections, paronychia, for example, require antibiotic and antifungal therapy treatment. A solution of povidone-iodine may work as well.
Studies have shown that cooling hands and nails during chemotherapy can decrease nail damage. For this reason, some cancer centers even provide ice packs that patients can use. However, nail changes can’t be prevented completely, and applying ice to your hands can be an uncomfortable experience.
Any changes to your fingernails and/or toenails should be reported to your cancer team. If you notice any signs of infection between visits, such as increased pain, redness around the cuticle, fever, rapid elevation of the nail bed, or any pus draining from your nail, you should contact your Oncologist as soon as possible.
Chemotherapy Skin Problems
The color or shape of your nails can change during cancer treatment. This is a common side-effect of many forms of cancer treatment. Some chemo drugs, such as taxanes, can even cause complete loss of nails, infections, and paronychia. The best way to take care of nail changes during chemotherapy is to take special care of your nails, in order to reduce the risk of infection. If the symptoms of infection around your nails still develop, patients should talk to their Oncologist.
Chemotherapy and other forms of cancer treatmentmay cause yournailsandnailbeds to change color, become brittle, grooved, lifted, or sensitive. Hope & Beauty offers ways to help manage these side-effects with our line of nail treatment products.
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