Many people are aware of the skin and hair changes that come with getting cancer treatment. But it's also common for your nails to be affected. Chemotherapy, immunotherapy, and other cancer treatments can affect the strength, color, and shape of your nails.
Chemotherapy works by attacking fast growing cells of the cancer but it can also affect fast growing good cells of the body such as those in the hair, skin and nails. Chemotherapy can cause the nails to change in a number of ways. Fingernails are affected more often than toenails. Once your treatment is done, it can take about six to 12 months for your fingernails to grow back out to normal. Toenails can take even longer – sometimes up to a year. In some cases, the nails never return to how they were before chemo.
Common nails changes as a result of chemotherapy
Nail weakness and loss: Nails can grow weak and brittle during chemotherapy. They may also lift up from the tissue that holds them in place (onycholysis). Less often, nails may fall off after several rounds of treatment. Your nails may become brittle and thin, grow slowly, and break easily. Some chemotherapy medications, such as taxanes (Taxol and Taxotere), are more likely to cause nail loss than others.
Black toenails: The toenails may take on a bruised appearance, turning various shades of black, brown, purple, blue and green.
Beau's lines: Colorless ridges known as Beau's lines may form on your nails. These ridges don't have any color, though they can appear lighter or darker than the rest of your nail. The ridges tend to be more horizontal than vertical.
Beau's lines themselves are harmless. Once your treatment is finished, the lines should grow out with the rest of your nail.
Koilonychia: Your nails may change shape, too. They may curve inward, forming a spoon-like shape. This is known as koilonychia. Koilonychia is different than clubbing, a process associated with lung cancer in which the fingers can take on a permanent spoon shape.
Secondary infections: A painful infection known as paronychia can form around your nail. Your body needs white blood cells to fight infection. However, chemotherapy lowers your white blood cell count (chemotherapy-induced neutropenia). If you get paronychia when your white blood cell count is low, your body could have a harder time fighting off the infection. You may need to take an antibiotic or antifungal therapy to help your body fight it.
Some treatments are more likely than others to affect your nails. Chemotherapy drugs that tend to cause nail symptoms include Taxanes such as Taxol (paclitaxel) and Taxotere (docetaxel), Anthracyclines such as Adriamycin (doxorubicin), 5-fluorouracil (5-FU), and Capecitabine.
If you are doing a taxane-based therapy, your oncologist may advise you to apply a hydrating nail solution once a day or as needed. Studies show that hydrating nail solutions may reduce the risk of nail loss due to Taxol chemotherapy.
Aside from chemo, other types of cancer treatments like targeted therapy and immunotherapy can also lead to nail changes. Some drugs used in these treatments are also more likely to cause nail problems than others.
Targeted therapies: The nail changes seen with targeted therapies differ from those seen with chemotherapy. Nail infections that affect the nail folds (paronychia), as well as pyogenic granulomas around the nails (sores that grow fast and bleed easily), are most common. Targeted therapies, especially EGFR inhibitors used to treat EGFR positive lung cancer, often cause nail problems.
Immunotherapy: The most common side effects of the immunotherapy drugs known as checkpoint inhibitors are conditions that end with "itis" (meaning inflammation) and can affect your skin and nails.
How to save your nails during chemo
Keep in mind that some cancer treatments can weaken your immune system. So if you get a nail infection, make sure to tell your oncologist. The quicker you get the infection treated, the less likely it is to damage your nails. If you have a collection of pus starting to form, you may need to see a podiatrist to have the nails cleaned up.
Things you can do to manage your symptoms and help prevent more problems
• Keep all your nails trimmed. Ideally, toenails should be cut short and straight across.
• Wear gloves when working. Cotton gloves can protect your hands during gardening. Use rubber gloves when cleaning or washing dishes to keep your hands from drying out.
• Don't bite your nails, as this increases the risk of infection. Wear cotton gloves if it's tough for you to break the habit.
• Avoid manicures, pedicures, fake nails, and cutting your cuticles. These can increase your risk of infection. If you do get a mani/pedi, bring your own supplies.
• In general, it is best to avoid nail polish. That said, some people find that using clear polish helps strengthen and may protect their nails.
• Some people find that soaking their hands in natural oils, such as olive oil, is helpful.
• Wear comfortable, roomy soft shoes that your toenails won't rub against.
• If one of your nails is loose, do not pull it off. Lightly cover it with a bandage or gauze (to avoid accidentally ripping off your nail) and let it fall off on its own.
Some studies suggest that cooling hands and feet during chemo might reduce nail damage and some cancer centers provide ice packs that people can use but this may also be uncomfortable during chemo. The belief is that the cold causes blood vessels to get small, temporarily decreasing blood flow to the feet and reducing the exposure to the chemotherapy drug and the effects. Several studies examining the effect of frozen gloves and socks for the prevention of docetaxel-induced onycholysis and skin toxicity. This glove study showed approximately 40 percent reduction in nail lifting (onycholysis) of the fingernails and 21 percent reduction in the toenails. This may be painful during chemotherapy. Ask you oncologist if this is an option for you.
When to call your doctor
Tell your cancer team about any nail changes you have during chemotherapy. Between visits, make sure to call with any signs of infection, such as pain, redness (especially around the cuticle), fever, rapid swelling of your nail bed, or any pus around your nails. If you are having toenail changes that are painful and infected it is time to see the podiatrist. Always speak to your oncologist prior to seeing the podiatrist or any other doctor.
• For more information email info@familyfootcentre.com or visit www.foothealthfacts.org or www.footlogix.com. To see a podiatrist visit Family Foot Centre on #45 Daffodil Avenue, Independence Highway or call 605-3668; Bahamas Surgical Associates Centre at Hill Top Medical, telephone 603-1814/5. In Grand Bahama visit Lucayan Medical Center on East Sunrise Highway or call 373-7400.
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