Magazine for the professional nail industry.
Issue link: http://nailsmag.epubxp.com/i/688035
128 | NAILS MAGAZINE | JULY 2016 } HEALTH A Day in the Life of a Nail Expert In this month's column, Dr. Stern discusses the efects of chemotherapy on the nail and the precautions you should take if a client has cancer. BY DR. DANA STERN Dermatologists treat skin, hair, and nails. I am a board-certifed dermatologist and one of the country's only nail specialists. My practice is entirely focused on the treatment of nail disorders including nail infections, infammatory diseases of the nail, cosmetic issues related to the nail, cancers of the nail, nail surgery, and sports-related nail injuries. I also see many nail issues that are related to medications, especially chemotherapy agents. Stern When you think about the side efects of chemotherapy, hair loss and nausea are probably what frst come to mind. While we are so fortunate to have an incredible arsenal of life-saving chemotherapeutic options, the side efects can pose considerable challenges for patients. Many are unaware that chemotherapy agents can also adversely afect the nails. Epidermal growth factor receptor (EGFR) inhibitors are a common class of chemotherapy drugs that can cause painful growths called pyogenic granulomas next to the nail (periungual) or under the nail within the nail bed (subungual). These growths have a prominent blood supply and tend to bleed easily, and they can be challenging to treat. I have had success surgically removing these growths for my patients who have sufered with this side efect. This class of chemotherapy drug can also cause paronychias (infammation, pain, swelling, and drainage surrounding the nail fold). Paronychias can be treated with drainage, antibiotics, and soaks such as the over-the-counter brand Domeboro. This preparation has astringent and antibacterial properties. Other side efects include painful openings at the fngertips (fssures) as well as brittle nails. There are a couple of prescription brittle nail treatments on the market. These nail lacquers are formulated to address fragile, brittle, or split nails. Genadur, a water-soluble nail lacquer, contains Hydroxypropyl-chitosan (HPCH) which penetrates intercellular spaces and nail surface ridges, providing physical support and creating a barrier against external agents. Another prescription option in this category is Nuvail, a polyuria-urethane protective barrier, which creates a stable yet fexible molecular structure within the nail plate and maintains moisture balance by preventing water absorption. Another common chemotherapy class are the Taxanes. Often used to treat breast cancer among other malignancies, these medications can cause separation of the nail plate from the underlying nail bed (onycholysis) as well as a specifc type of onycholysis where the underlying nail bed bleeds and is painful (hemorrhagic onycholysis). This side efect can be very uncomfortable for patients. Treatment includes keeping the nails short to prevent organisms, chemicals, moisture, and debris from entering under the nail. Yeast is the most common culprit and often a prescription topical antifungal agent is warranted. A compromised barrier can also predispose Chemotherapy-induced pyogenic granuloma of the nail bed Chemotherapy-induced periungual pyogenic granuloma Chemotherapy-induced onycholysis Chemotherapy-induced hemorrhagic onycholysis