Unilateral onycholysis in a patient taking erlotinib (Tarceva)

Abstract

Targeting epidermal growth factor receptor (EGFR)-mediated signalling pathways has become routine practice in the treatment of lung cancer. Erlotinib is an oral EGFR tyrosine kinase inhibitor, licensed for maintenance monotherapy treatment in patients with locally advanced or metastatic non-small cell lung cancer after first-line chemotherapy. The authors present the case of a 51-year-old patient who had an excellent response to erlotinib, but developed unilateral onycholysis as an unusual side effect. The authors discuss erlotinib-induced skin and nail changes and have provided a brief literature review on the available evidence for their management.

Figure 1

Presenting chest x-ray demonstrating lower and middle lobe consolidation, and bilateral patchy infiltrates.

Figure 2

Chest x-ray demonstrating bilateral pneumothoraces with surgical emphysema affecting the neck and chest.

Figure 3

Chest x-ray after two cycles of erlotinib demonstrating resolution of the bilateral lung changes.

Figure 4

(a,b) Unilateral onycholysis of the nails of the left foot (with permission from patient).