Nail changes in patients undergoing cancer chemotherapy

Abstract

Background: Anti-cancer chemotherapy is associated with a myriad nail changes ranging from cosmetic disfigurement to severe changes which may require an alteration in the cancer chemotherapeutic regimens. The objective of the study was to analyse the nail changes in patients undergoing cancer chemotherapy.Methods: Screening was done for all in-patients undergoing cancer chemotherapy and out-patients referred to Dermatology from Oncology. All nail changes were documented according to a proforma and an attempt was made to establish a relation, if any, with a chemotherapeutic agent group.Results: A total of consecutive 150 patients undergoing cancer chemotherapy were screened, out of which nail changes were observed in 50 patients. The age group of patients ranged from 12yrs to 73yrs. The Male: Female ratio was 2.7:1. Following platinum based agents, the nail changes were seen in 54% of patients. There was a significant association of nail changes following chemotherapy with a p value of 0.00001%. Pigmentary changes were the most common nail plate changes. Longitudinal pigmentary bands were the most common pigmentary nail plate changes seen in 67.7% of patients following chemotherapy with platinum based agents, and 16.1% of patients following CHOP regimen. Diffuse pigmentation of nail plate was most common nail plate change (16.1%) following chemotherapy with taxanes. Muehrcke’s lines were the most common nail bed changes seen in 57.1% of patients following treatment with platins. Half and half nails and onycholysis were seen in 42.85% of patients following CHOP chemotherapy. Pigmentation of the nail folds were the most common changes seen in 40% of patients following platinum based agents and CHOP chemotherapy.Conclusions: A variety of nail changes can be associated with cancer chemotherapy. A knowledge about the various changes ranging from those of cosmetic concern to serious changes in patients who are undergoing chemotherapy is vital for the successful management of the patient.