Onycholysis Associated with Weekly Administration of Paclitaxel

Flory, Stefanie M.; Solimando, Dominic A.; Webster, Guy F.; Dunton, Charles J.; Neufeld, Julia M; Haffey, Mary B.

doi:10.1345/aph.18307

Cited by 32 publications

(24 citation statements)

References 5 publications

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“…Such nail changes during docetaxel treatment are usually not severe, but subungual hematomas and hemorrhagic onycholysis can occur, leading to an impaired quality of life or to a discontinuation of chemotherapy. Direct nail bed toxicity or inhibition of nail bed angiogenesis related to taxane-mediated effects are suggested to be possible mechanisms leading to onycholysis 9,10. Considering that pain was reduced following spontaneous drainage of the subungual hemopurulent material, pressure effect due to hemorrhage seems to be the more direct cause for pain in these patients.…”

Section: Discussionmentioning

confidence: 99%

Docetaxel-Induced Onycholysis: The Role of Subungual Hemorrhage and Suppuration

2007

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Nail changes are common side effects of taxane chemotherapeutic agents. Docetaxel (Taxotere®) is known to cause a great incidence of nail change. Various types of nail changes have previously been reported as a result of treatment with taxanes. We describe 2 cases of severe nail changes induced by docetaxel. The patients had previously been diagnosed with breast cancer and advanced gastric cancer, respectively. During the course of treatment with docetaxel, nail changes became apparent in both patients. Initially, they complained of nail bed purpura. Subungual hematomas with hemopurulent discharge were later observed in several fingers. Drainage of the hemopurulent material occurred spontaneously in our cases, leading to onycholysis. Following drainage, the pain in the nail with subungual hemoprulent material was relieved immediately and spontaneous healing of the patients' nails was noticed after few months. Subungual hemorrhage and suppuration therefore are considered causes of onycholysis and the pain in these patients. Although systemic or topical antibiotics were not used to treat these patients, antibiotics may be also worthwhile to hasten the drainage of the subungual hematomas and suppuration in patients for quick relief of pain.

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Section: Discussionmentioning

confidence: 99%

Docetaxel-Induced Onycholysis: The Role of Subungual Hemorrhage and Suppuration

2007

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“…Chemotherapy-related cytotoxic injury to this epithelium could contribute to the development of onycholysis. 84, 87 A neurogenic mechanism was first proposed based on the sparing of toxicity in the paretic hand of a patient who had docetaxel-induced onycholysis in the other three extremities. 88 The authors hypothesized two particular neurogenic mechanisms: the first is related to persistent neurogenic inflammation from taxane-induced stimulation of cutaneous nociceptive C-fibers and the second is related to taxane-induced release of pro-inflammatory mediators that promote maintenance of nociceptive primary afferent stimulus (peripheral sensitization).…”

Section: Chemotherapy-induced Onycholysismentioning

confidence: 99%

Supportive Cryotherapy: A Review From Head to Toe

Kadakia

Rozell

Butala

et al. 2014

Journal of Pain and Symptom Management

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Context Conventional chemotherapy leads to multiple adverse mucocutaneous complications including oral mucositis, alopecia, ocular toxicity, and onycholysis. Limited pharmacologic interventions are available for preventing these clinical problems. Objectives This study aimed to critically review the role of cryotherapy (regional hypothermia) for alleviating these adverse symptoms. Methods A narrative review was performed, with an emphasis on randomized controlled trials. A comprehensive search using PubMed, Ovid, Embase, and MEDLINE® was completed. References of all cited articles also were reviewed. Data from the review were comprised of articles published between 1970 to May 2013. Results Available evidence suggests that regional hypothermia decreases the burden of chemotherapy-related oral mucositis, alopecia, ocular toxicity, and onycholysis. The major limitations of studies include the absence of blinded control groups and variable clinical endpoints. Conclusion Regional hypothermia decreases the burden of these four chemotherapy-induced complications and is well tolerated. More research is needed to determine what subgroups of cancer patients are most likely to respond to different types of regional hypothermia, the ideal duration of cooling needed, and to further improve the ease of use of the cooling devices.

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“…Third, spontaneous resolution of nail changes despite continued treatment with taxanes was observed. [5] In the current case, the nail-related morbidity became worse even after stopping docetaxel, and improvement started only 6 weeks after cessation of trastuzumab. Thus, the contribution of trastuzumab to burden of nail dystrophy in addition to docetaxel is highly plausible.…”

mentioning

confidence: 70%