Annals of Oncology Advance Access originally published online on September 21, 2005
Annals of Oncology 2006 17(3):527; doi:10.1093/annonc/mdj015
© 2005 European Society for Medical Oncology
letter to the editor |
Unilateral nail changes secondary to adriamycin: the protective effect of brachial plexopathy
Nail changes are commonly observed in patients receiving cytotoxic chemotherapy. A 53-year-old woman with metastatic breast cancer presented with right arm pain and weakness. Clinically she had a right supraclavicular fossa mass, brachial plexopathy and Horner's syndrome. Her right interossei and thenar eminence were wasted but her arterial pulses were well preserved. Nerve conduction studies confirmed a complete brachial plexopathy with extensive denervation in all three trunks of the brachial plexus. She commenced chemotherapy with adriamycin and cyclophosphamide and had a good partial response after three cycles, with shrinkage of the mass and improved right arm function. She developed white transverse lines on the nails of her left hand with each cycle of chemotherapy but the nails of her right hand were spared (Figure 1). Bilateral transverse leukonychia has previously been reported in patients recieving anthracyclines [1
, 2] and is well recognized in clinical practice. It is theorized that cytotoxic drugs inactivate the nail matrix leading to altered nail pigmentation, which moves distally as the nail matrix recovers and produces normal nail plate until the next cycle of chemotherapy is administered causing a new band of altered pigmentation.
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Unilateral nail changes in patients with contralateral brachial plexopathy have been reported with docetaxel use [3
]. It has been proposed that the nail bed is damaged by neuropeptides released by nocioceptive C-fibres exposed to taxanes, and that nerves already damaged by brachial plexopathy cannot release these. It is also mooted that COX-2 inhibitors may prevent release of pro-inflammatory prostaglandins from sympathetic postganglionic terminals and protect the nail bed [4]. We report unilateral nail damage secondary to anthracycline use that may indicate a similar neurogenic mechanism for anthracycline-induced nail changes and a possible role for COX-2 inhibitors in their prevention. To our knowledge this is the first report of unilateral anthracycline-induced nail changes.
1 Department of Medical Oncology, Cork University Hospital, 2 Department of Surgery, Cork University Hospital, Ireland
* (E-mail: oreillys{at}shb.ie)
References
1. Naumann R, Wozel G. Transverse leukonychia following chemotherapy in a patient with Hodgkin's disease. Eur J Dermatol 2000; 10: 392–394.[Web of Science][Medline]
2. Shelley WB, Humphrey GB. Transverse leukonychia (Mees' lines) due to daunorubicin chemotherapy. Pediatr Dermatol 1997; 14: 144–145.[Medline]
3. Wasner G, Hilpert F, Baron R, Pfisterer J. Clinical picture: nail changes secondary to docetaxel. Lancet 2001; 357: 910.[CrossRef][Web of Science][Medline]
4. Minisini AM, Tosti A, Sobrero AF et al. Taxane-induced nail changes: incidence, clinical presentation and outcome. Ann Oncol 2003; 14: 333–337.
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