Nail changes with docetaxel

These fingernail and toenail changes were noted 8 weeks after the start of docetaxel chemotherapy in a 40-year-old patient with breast cancer. Onycholysis, where separation of the nail plate starts distally, is an unusual side effect of taxanes. Other features are nail pigmentation, subungual hematoma, sterile abscesses, Beau lines, and acute paronychia. Prompt recognition avoids unnecessary antibiotics and antifungals. Therapy can continue, and using a frozen glove reduces the incidence of this side effect. The lesions heal slowly, with regrowth of the nails after the taxane is discontinued.