Docetaxel-induced onycholysis: the role of subungual hemorrhage and suppuration

Abstract

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.

Fig. 1

Nail changes of both hands (A) and feet (B) in the form of dyschromasia, dystrophy, onycholysis and subungual hematoma.

Fig. 2

Nail changes of all the digits in both hands and both 1^st toes in the form of dyschromasia, dystrophy, onycholysis, hemorrhagic onycholysis and subungual hematoma. Purulent discharge was observed when the right 5^th fingernail nail was pressed.