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Fingernail Disorders During Breast Cancer Chemotherapy

Causes, Care, Prevention

By

Updated June 30, 2014

Your fingernails reveal a lot about your health. During chemotherapy for breast cancer, you may experience problems with the nails on your fingers and toes. Understanding the causes and symptoms of nail disorders can help you care for them.

Symptoms of Fingernail Disorders During Chemotherapy

Onycholysis
Onycholysis: loose fingernails caused by docetaxel. (Photo: A. M. Minisini, Annals of Oncology)
Nails may darken or turn yellow, become brittle and crack easily. Six or more high-dose cycles of taxanes may cause nails to fall off. Dark or light lines (Beau's lines) may develop across the width of some of your nails. Nails may develop a concave, spoon-like shape (koilonychia). Infections under your nails are also possible. If your nails are becoming loose, they may become quite painful. In the photo, Docetaxel caused nails to loosen, with blood collecting under each nail.

Causes of Chemo-Related Fingernail Problems

Beau's Lines
Beau's Lines fingernail disorder. (Photo: A. M. Minisini, Annals of Oncology)
Because chemotherapy is very drying to your tissues, your nails can become brittle and yellow. Dry nails will break and crack easily. Koilonychia (spooning) is caused by anemia and low iron. Beau's lines occur when you have high-dose chemo, and your nails temporarily stop growing. You may develop one visible line per high dose chemo cycle. Low-dose chemo can cause Beau's lines as well, but these will be difficult to see without a microscope. In the photo, Beau's lines and related cracks appear on a patient's fingernails.

Some Chemotherapy Drugs That Can Cause Fingernail Disorders

Prevention of Nail Disorders

Chemo-related nail problems are not totally preventable. At some clinics, the nurse may bring you a dish of ice water for your hands. Research suggests that using ice or cryotherapy, such as frozen gloves, may reduce damage to skin and nails. Ice is sometimes used for the hands and mouth during an infusion, because that’s when the drugs are most toxic to your cells.

Self-Care for Nails During Chemotherapy

  • Use clear polish to help keep nails strong
  • Avoid artificial nails and colored polish, especially dark colors
  • Wear gloves when washing dishes and gardening
  • Care for nails and cuticles gently
  • As Beau's lines grow beyond nail bed, cut them off
  • Increase iron in your diet
  • Cut back on or avoid caffeine
  • Try taking vitamins for hair, skin, and nails
  • Wear comfortable shoes that allow adequate room for your toes

When to See a Health Professional

If you are having nail pain, or your nails appear infected or badly discolored, tell your nurse or doctor about it. Infections can be treated with antibiotics or other medications. Pain and discoloration should be diagnosed and treated by a health professional.

Your Nails Will Recover

Even if your nails disappear during chemo, or become lined or discolored, your skin and nail cells will start growing again at a healthy rate when treatment ends. New nail tissue will push the damaged nails out of the way. Fingernails grow three times faster than toenails, so allow more time to see improvements on your toes.

About Joseph Honoré Simon Beau

French physician Joseph Honoré Simon Beau described transverse lines in nails in 1846. Beau's lines are named after him. Beau specialized in the physiology of the heart and lungs. These lines are also called Beau-Reil lines, to honor German anatomist Johann Christian Reil, who noted this phenomenon in 1796.

Sources

Journal of Clinical Oncology, July 1, 2005. Frozen Glove Reduces Skin and Nail Damage from Docetaxel Chemotherapy.

Annals of Oncology. Annals of Oncology 14:333-337, 2003. Taxane-induced nail changes: incidence, clinical presentation and outcome. Authors: A. M. Minisini, et. al.

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