住院醫師園地
Acute and Painful Nail Changes after Docetaxel
Treatment
Feng-Jang Wu
Chia-Yu Chu*
Pei-Lin Chung
CASE REPORT
A 28-year-old man (patient A) and a 46-year-old female (patient B) were diagnosed as having
adenocarcinoma of the lung and received docetaxel chemotherapy to substitute previous regimen (gemcitabine and cisplatin) due to poor response. No significant adverse effects noted until the fourth cycle
of docetaxel treatment, both patients developed nail changes. Both had acute nail pain for one week.
On examination of patient A, orange discoloration of fingernails without discomfort and painful
paronychia of toenails was noted. (Fig. 1) Regarding patient B, acute paronychial change of fingernails
with purulent discharge, onycholysis, subungual hemorrhage or yellowish discoloration was presented. (Fig. 2) Bacterial culture revealed negative result. The lesions were managed with topical antibiotic
ointment. The painful paronychia gradually improved in a few days.
Fig. 1
Fig. 2
From the Department of Dermatology , Taipei Hospital, Department of Health and National Taiwan University Hospital*
Accepted for publication: Febuary 20, 2003
Correspondence and reprint requests: Chai-Yu Chu, M. D., Department of Dermatology, National Taiwan University Hospital, No. 7,
Chung-Shan South Road, Taipei 100, Taiwan, R.O.C.
TEL: 02-23562141
FAX: 02-23934177
302
Diagnosis: Docetaxel - Induced Nail
Changes
DISCUSSION
Docetaxel ( Taxotere ® ), a semisynthetic
taxoid, acts as an antimicrotubule agent and is
considered to have great potential in the treatment of breast, ovary and lung cancer. The most
common side effects are hematological ones.
Skin and nail toxicity is one of the most frequent non-hematological adverse reactions.1
Nail involvement is observed in 26 % of
docetaxel treated patients. Besides dark pigmentation and Beau's lines, subungual hemorrhage, orange or yellowish discoloration,
painful paronychia, onycholysis, subungual
abscess, subungual hyperkeratosis and transverse loss of the nail plate had been described.
Nail pigmentation is the most frequent change
and usually appears 3-8 weeks after the initiation of chemotherapy. The most frequent reported color of nail pigmentation after receiving
docetaxel was yellow or orange discoloration,
which was also observed in both of our patients.
Acute paronychia is not a frequent finding with
antineoplastic drugs but has been described
with docetaxel. Of these reported cases, fingernails seemed to be more frequently involved
than toenails.2-4
The average time elapsing from treatment
to development of the nail changes, varying
from 1 to 9 weeks in the previous reports, was 4
weeks in our cases. The regimen of our patients,
weekly infusion of docetaxel 36 mg / m 2 for
consecutive 3 weeks followed by 1- week off,
was different from those previously reported (110 mg / m2 every 3 weeks).2-4 Some investigators have suggested weekly administration of
docetaxel at a lower dosage to increase the frequency of exposure of cancer cells to docetaxel
as well as to decrease drug toxicity.5 But our
presenting cases still developed these manifestations with lower dosage schedule. Similar nail
reactions tend to recur during subsequent cycle
of docetaxel treatment.2-4 We didn't observe this
phenomenon due to alteration of the chemother-
303
apy regimen for the poor response of the docetaxel treatment. More case reports are needed
to clarify the relationship between the elapsing
time, dosage schedule and the development of
the nail changes.
There was no history of previous skin
injury or exposure to sunlight over this area in
our cases. The negative result of microbial culture and striking symmetry in nail involvement
suggested that infection was not a primary
event. Except for antiemetics and methylprednisolone, no other drugs were simultaneously
given, which had no similar side effects reported. The relation between these nail adverse
reactions and docetaxel intake is obvious.
Most of these nail changes described
before were treated symptomatically, well tolerated, and didn't necessitate the discontinuation
of treatment. Nail regrowth often restarted after
the discontinuation of the drug without sequelae. Docetaxel is nowadays widely used, clinicians should recognize the different spectrum of
skin and nail changes induced by this new drug.
REFERENCE
1. Ringel I, Horwitz SB: Studies with RP
56976 (taxotere): A semisynthetic analogue
of Taxol. J Natl Cancer Instit 83: 288-291,
1991.
2. Correia O, Azeved C, Ferreira EP, et al.:
Nail changes secondary to Docetaxel
(Taxotere). Dermatology 198: 288-290,
1999.
3. Vanhooteghem O, Andre’ J, Vinderoghel A,
et al.: Docetaxel-induced subungual hemorrhage. Dermatology 194: 419-420, 1997.
4. Vanhooteghem O, Richert B, Vindevoghel
A, et al.: Subungual abscess: a new ungual
side-effect related to docetaxel therapy. Br J
Dermatol 143; 462-464, 2000.
5. Hainsworth JD, Burris HA, Erland JB, et al.:
Phase I trial of docetaxel administered by
weekly infusion in patients with advanced
refractory cancer. J Clin Oncol 16: 21642168, 1998.
Dermatol Sinica, September 2003