Introduction to Anticancer Therapies
Gabriella Fabbrocini, Mario E. Lacouture, Antonella Tosti in Dermatologic Reactions to Cancer Therapies, 2019
Overall incidence of skin, nail, and hair side effects to chemotherapeutic agents, including taxanes (46%), PLD (7%), other anthracyclines (19%), topotecan (14%), and other agents (14%), is reported to be 86.8%, and among them 23.1% developed nail changes (6). Cytotoxic chemotherapeutic agents can damage the nail matrix and cause transverse ridges across the nail plate, that is, Beau's lines, which are usually self-limited (31). Onycholysis occurs when the nail bed is involved. Pain, paronychia, granulation tissue growth, nail loss, and secondary bacterial infection with abscess formation may complicate onycholysis which can affect the patient's activities of daily living and quality of life (32). Common nail changes related to chemotherapy also include brittle nails, discoloration, splinter hemorrhage, subungual hematoma, and hyperpigmentation (32).
Answers
Ken Addley in MCQs, MEQs and OSPEs in Occupational Medicine, 2023
The following are appropriate and found in patients with psoriasis: Onycholysis: separation of the nail from its bed.Distal nail bed hyperkeratosis: Subungual hyperkeratosis is a disorder characterised by an excessive reproduction of skin cells that accumulate between the nail and the nail bed. Also involves thickening and lifting of the nail.Splinter haemorrhages: A splinter haemorrhage is a longitudinal, red-brown haemorrhage under a nail and looks like a wood splinter.Oil-drop or salmon-patch is a translucent yellow-red discolouration in the nail bed proximal to onycholysis. It reflects inflammation and can be tender.
How to prevent and treat chemotherapy-induced nail abnormalities
Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke in Nail Therapies, 2021
Furthermore, the patients can be advised about preventative measures to limit nail toxicities (nail plate changes, onycholysis and periungual lesions) (Robert et al. 2015; Lacouture 2015):Keep fingernails as dry as possible.Always use a double pair of gloves (first in cotton and second in vinyl, nitrile, or latex).Avoid repeated trauma or friction from manicuring and restrict frequent use of nail polish and nail polish removers.Use wide and comfortable shoes.Apply topical emollients to cuticles and periungual tissues frequently.Some nail lacquers such as hydroxypropyl chitosan or polyurethane 16% seem to be useful to reduce water evaporation from the nail plate and have a barrier effectCollaboration with a podiatrist can be useful.
Use of in vitro performance models in the assessment of drug delivery across the human nail for nail disorders
Published in Expert Opinion on Drug Delivery, 2018
Marc Brown, Rob Turner, Sean Robert Wevrett
Distal and lateral subungual onychomycosis is the most prevalent form of the nail condition and is commonly believed to take hold in a fissure at the lateral edge of the nail, as often individual nails present the disease while other nails on the same hand or foot will be asymptomatic. The infection then spreads to the underside of the nail and the nail bed, where hyperkeratosis leads to onycholysis. At this stage, the nail may thicken and become friable and then lift away from the nail bed [11,18], which reduces the effectiveness of systemic treatment as the fungus occupies an air space through which a drug cannot permeate. Furthermore, onychomycosis does not spontaneously resolve without treatment and can take up to a year to correct using current topical or systemic treatments [1–3,20,21]. There is also thought to be a 50% rate of recurrence when adhering to the current recommended treatment procedures [22], potentially due to reinfection from fungal spores in the environment, such as within socks.
Pemigatinib in cholangiocarcinoma with a FGFR2 rearrangement or fusion
Published in Expert Review of Anticancer Therapy, 2022
Michael H. Storandt, Zhaohui Jin, Amit Mahipal
With regards to cutaneous adverse effects, including stomatitis, preventative measures, such as oral hygiene and skin moisturizers are recommended, and stomatitis may be managed with dexamethasone, doxycycline and sucralfate oral rinses [39,87]. For intolerable grade 2 or greater toxicity, dermatology consultation should be considered and the FGFR inhibitor may be held for 7 days, and if grade 3 or greater toxicity persists in spite of dose reduction, the medication may require discontinuation [87]. Patients who develop onycholysis should undergo evaluation for onychomycosis [39]. Management of chronic dermatologic and nail toxicities becomes more relevant as patients remain on FGFR inhibitors for longer duration. Early consultation with podiatry can potentially be beneficial in managing the AEs.
Safety of current therapies for onychomycosis
Published in Expert Opinion on Drug Safety, 2020
Jose W. Ricardo, Shari R. Lipner
Onychomycosis affects the toenails much more frequently than the fingernails, and the great toenail is the most common digit involved[1]. Onychomycosis presents clinically with nail yellowing, onycholysis and subungual hyperkeratosis[1]. In long-standing and more severe cases there may be pain, with extensive onychodystrophy, including nail plate thickening, crumbling, ridging, onychocryptosis, and partial or complete nail loss[1]. Onychomycosis is associated with significant negative impact on patient quality of life (QOL); especially in females and in patients with fingernail involvement[13]. Feelings of shame and stigmatization due to the negative esthetic appearance are common among patients with onychomycosis[13]. In the US, there were 1.3 million visits to physicians for onychomycosis by 662,000 Medicare patients in 1989–1990, with a cost of USD 43 million. Therefore, onychomycosis is an important disease with a significant impact on QOL and is associated with substantial health care costs[14].
Related Knowledge Centers
- Dermatitis
- Hyperthyroidism
- Sympathetic Nervous System
- Infection
- Psoriasis
- Nail
- Ring Finger
- Injury
- Idiopathic Disease
- Raynaud Syndrome