Systemic Drug-induced Chronic Paronychia and Periungual Pyogenic Granuloma

Abstract

Paronychia is a painful inflammatory disorder of the nail fold. Periungual pyogenic granuloma - a benign vascular tumor of the capillaries - can develop as a complication of paronychia. We report both, paronychia and periungual pyogenic granuloma, as possible adverse events during systemic drug-therapy. The following groups of systemic drugs have been considered: taxanes, epidermal growth factor-receptor (EGFR) inhibitors, EGFR tyrosine kinase inhibitors, tyrosine kinase inhibitors, inhibitors of MEK/ERK, BRAF inhibitors, CD20 antagonists, vascular endothelial growth factor inhibitors, and retinoids. Recommendations for prevention and treatment are given. Since paronychia is a painful inflammatory disorder that has a negative impact on daily activities, early recognition and adequate treatment improve adhesion to treatment and quality of life.

Keywords: Adverse events; nail apparatus; paronychia; pyogenic granuloma; systemic drug therapy; treatment.

Figure 1

Chronic paronychia due to irritant contact dermatitis with transverse nail plate lines

Figure 2

Pyogenic granuloma on the right second toe

Figure 3

Chronic paronychia in combination with multiple periungual pyogenic granulomas in a 73-year-old female patient treated with panitumumab for signet ring carcinoma of the caecum

Figure 4

Bilateral severe chronic paronychia and livid discoloration of skin with pyogenic granuloma on the left great toe during palliative nonsmall cell lung cancer treatment with osimertinib

Figure 5

Chronic paronychia with pyogenic granuloma in a patient treated with rituximab for rheumatoid arthritis

Figure 6

Chronic paronychia of the medial nail fold in a colorectal cancer patient treated with bevacizumab