Sophia Delgado
Chemotherapy can cause changes to your fingernails and toenails, including discolouration, slow growth, and brittleness. In some cases, nails may lift from the nail bed or fall off completely, leaving the site vulnerable to bacterial infections. These nail changes can be long-term or short-term, and they usually disappear once treatment ends and nails grow out. To reduce the risk of infection, it is important to maintain nail hygiene and avoid manicures during chemotherapy.
| Characteristics | Values |
|---|---|
| Nail changes | Horizontal and vertical lines, indentations, ridges, slow growth, nail lifting, nail falling off, discolouration, nail infections, ingrown nails, brittle nails, thin nails |
| Cancer treatments causing nail changes | Chemotherapy, targeted therapy, immunotherapy, hormonal therapy, steroids |
| Preventative measures | Water-soluble nail lacquer, prescription nail polish, cold packs, moisturizers, protective gloves, soft padded shoes, cotton socks, short nails, cleansers, cuticle remover cream, cuticle stick, cuticle cream |
| Side effects | Increased risk of infection, inflammation, pain, rashes, dry skin, spots, acne, itching |
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What You'll Learn
Nail plate issues: nails may lift or fall off
Chemotherapy and other cancer treatments can cause nail changes, including issues with the nail plate. The nail plate is the hard part of the nail that covers the soft nail bed underneath. During chemotherapy, the nail plate can become damaged, leading to nail lifting or nail loss. This condition is known as onycholysis.
Onycholysis occurs when the nail separates from the nail bed, creating a gap between the two layers. This separation can be partial or complete, and it can affect one or more nails. In some cases, the nail may fall off entirely. While this can be distressing, it is important to remember that nail changes during chemotherapy are usually temporary.
There are several ways to manage nail plate issues during chemotherapy. Firstly, it is essential to practice good nail hygiene and take steps to prevent infection. Keep your nails clean and trim them regularly to prevent bacteria from accumulating. Avoid picking at your nails or cuticles, as this can create openings for bacteria to enter.
Additionally, consider using moisturizers and cuticle creams to keep the nail bed and cuticles hydrated and healthy. Wearing cotton gloves after moisturizing can help lock in moisture and protect your nails from potential damage. It is also recommended to wear protective gloves when performing household tasks or gardening to shield your nails from chemicals and injuries.
In some cases, healthcare providers may recommend the use of cold packs during chemotherapy infusions to help prevent nail lifting. This involves applying cold packs to the hands and feet before, during, and after the infusion. However, it is important to consult with your healthcare team before using this or any other method to manage your nail changes.
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Growth problems: slower growth, or no growth at all
Chemotherapy can cause growth problems in nails, resulting in slower growth or even complete cessation of growth. These growth problems can be temporary or permanent. During chemotherapy, the nail plate stops growing with each infusion, and may grow a little between infusions, leading to horizontal ridges, known as Beau's lines.
Some patients may experience nails that grow back thick and painfully after chemotherapy, requiring the nail to be removed. In some cases, the nail matrix is killed to prevent regrowth due to patient preference for no nails over painful nails.
To manage nail growth problems during chemotherapy, it is recommended to keep nails short and smooth. Protective gloves should be worn during household tasks and gardening to prevent injury and exposure to chemicals. Keeping hands and nails clean is important for infection prevention, but very hot water should be avoided. Cotton socks and comfortable shoes are also recommended to protect the toenails.
Additionally, patients should be cautious when receiving manicures and pedicures due to the increased risk of infection. Cuticles should not be manipulated, and any changes to the nails that cause symptoms such as pain or odour should be reported to a doctor.
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Infections: nail infections, more common if nails are cracked
Chemotherapy and certain targeted therapies can cause changes to your nails. These changes include horizontal ridges (Beau's lines), increased pigmentation, slower growth, and nails lifting from the nailbed or coming off completely.
Nail infections, or paronychia, are more common if nails are cracked or open. Paronychia is caused by bacteria that enter the skin through cuts in the cuticle and the nail fold (the skin around the nail). This can be caused by biting or chewing nails or hangnails, cutting cuticles too closely, or cutting nails too short. It can also be caused by irritation from water or chemicals, trauma to the nailbed or cuticle area, or ingrown nails.
To prevent nail infections, maintain good hygiene by washing your hands and keeping your nails clean. Use gentle soaps that are not irritating to the skin and avoid harsh nail products that may weaken and dry out your nails, such as nail polish and nail polish remover. Keep your nails moisturized with lotion, especially after washing your hands or showering. If you spend a lot of time with your hands in and out of water, your nails can start to split, so wear protective gloves when doing household tasks or gardening.
If you notice any signs of infection, such as abnormal nail growth, ridges, discoloration, dryness, or brittleness, seek medical advice. Paronychia is usually treated with antibiotics. However, if left untreated, it can lead to more severe infections that may require surgical intervention.
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Pigmentation changes: increased pigmentation in the nail plate
Chemotherapy can cause pigmentation changes in the nail plate, resulting in increased pigmentation that may not go away. Although this change is typically asymptomatic, it may cause concern among patients who fear the development of nail melanoma or skin cancer beneath the nail. It is important to note that if a new dark line appears on a single nail, medical care should be sought. However, if there is a known reason for nail pigmentation, such as a vitamin deficiency, and multiple nails are affected, it is usually not a cause for worry.
During chemotherapy, it is crucial to be gentle with your nails and take extra care of them. Any changes to your nails that cause symptoms like pain or an unusual odour should be brought to the attention of your doctor for further evaluation.
To maintain nail health during cancer treatment, it is recommended to keep your nails clean and trimmed short. Protective measures such as wearing gloves during household tasks or gardening can help prevent injuries and exposure to chemicals. Avoiding tight-fitting shoes and manicures or pedicures that manipulate the cuticles is also advisable to minimise the risk of infection.
Additionally, some chemotherapy medications, such as taxanes (including docetaxel), may benefit from the application of cold packs to the nails before, during, and after the infusion to prevent nail lifting. However, it is essential to consult with your nurse or doctor before using this method.
While most nail changes from chemotherapy are short-term, resolving within a few months of completing treatment, some individuals may experience longer-term side effects. In rare cases, nails may grow back thick and painful, requiring further intervention. Overall, it is important to monitor any nail changes and seek medical advice as needed to address any symptoms or concerns.
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Nail bed issues: dryness, fraying, and ingrown nails
Chemotherapy and other cancer treatments can cause nail changes, including dryness, fraying, and ingrown nails. These changes can affect the nail plate, nail bed, or the area around or under the nail.
Dryness and fraying
The nail bed may become dry during chemotherapy, and cuticles may become frayed. To prevent dryness, it is recommended to keep the nail bed and cuticles moisturized with fragrance-free creams or ointments. Try using thick creams or ointments and wear cotton gloves after moisturizing. It is also important to avoid harsh products that can dry out the skin and to limit exposure to very hot water.
Ingrown nails
Chemotherapy can cause nails to become loose or fall out, which may result in ingrown nails. Ingrown nails can develop on the fingers or toes and can be treated by soaking the affected area in warm water and applying antibiotic cream. It is important to keep nails short and well-maintained to prevent ingrown nails.
It is advised to consult a healthcare provider if you experience any nail changes during chemotherapy, as these changes may increase the risk of infection. Chemotherapy can weaken the immune system, making it more difficult to fight off bacteria and other invaders. Therefore, it is crucial to take steps to reduce the risk of infection and protect the nails during treatment.
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Frequently asked questions
Yes, chemotherapy can cause nail changes, including nails lifting from the nail bed or falling off completely.
Chemotherapy can cause nails to fall off due to the temporary disruption in nail growth caused by infusions. Chemotherapy can also weaken the immune system, making it harder to fight off bacteria and other invaders, which can lead to nail infections.
Yes, other nail changes during chemotherapy can include ridges or lines across the nails, slower nail growth, nails becoming brittle or thin, changes in nail colour, and nail infections.
To manage nail changes during chemotherapy, it is recommended to keep nails short and smooth, avoid manicures and pedicures, and prevent nail injuries. Keeping the hands and nails clean is also important, but excessive water exposure should be avoided as it may lead to fungal infections. Moisturising the hands and nails with fragrance-free creams can help, as well as using cuticle creams to prevent dryness and splitting.
