BACKGROUND Onycholysis has been reported in association with the use of several noncytotoxic drugs and with chemotherapy in 135 patients. Onycholysis may be precipitated by exposure to ultraviolet radiation. METHODS The authors studied 91 patients who received paclitaxel and 187 patients who received doxorubicin. RESULTS Onycholysis occurred in 5 of 21 patients who received > 6 courses of weekly paclitaxel, developing in the summer months in all 5 patients. It did not occur in patients who received fewer weekly paclitaxel courses or those who were treated every 3 weeks. Onycholysis did not occur in 187 patients who received doxorubicin. Review of the literature revealed that onycholysis is nearly exclusively associated with anthracycline and taxane therapy. CONCLUSIONS Prolonged weekly paclitaxel, other taxanes, and anthracyclines cause onycholysis in some patients, which may be precipitated by exposure to sunlight. Patients receiving these drugs should protect their nails from sunlight. Cancer 2000;88:2367–71. © 2000 American Cancer Society.

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A 27-year-old secretary presented to an orthopaedic outpatients department with a 1-month history of left wrist drop following dry needling. On insertion of a needle, she reported spasms in her left hand followed by a wrist drop. An MRI scan was normal. Electromyogram and nerve conduction studies showed a neuropraxia of the left radial nerve. She was referred to a hand therapist for splinting and intensive hand therapy; however, her symptoms remain unchanged.