Effective treatments for paronychia caused by oncology pharmacotherapy

Abstract

Cutaneous adverse events are relatively common in patients being treated with molecular-targeted drugs. Paronychia is one of the cutaneous adverse events that influences the patient's quality of life because of pain, and it often affects anticancer treatments in severe cases. However, there are few effective treatments, especially for severe paronychia. Here, we present our experiences of treatment for paronychia due to oncology pharmacotherapy. Although we treated paronychia with various methods, only corticosteroid ointment and phenol chemical matricectomy significantly improved the paronychia. Dermatologists must perform appropriate and effective treatments for paronychia in order to enable patients to continue anticancer drug treatment without impairing their quality of life.

Update review of skin adverse events during treatment of lung cancer and colorectal carcinoma with epidermal growth receptor factor inhibitors

“…usually with secondary inflammation, characterized by edema, redness, nail fold and severe pain in the area around the nail plate, even progression to onycholysis or onychodystrophy. The big toe is commonly the first area to be affected, and eventually one or more fingers and toes were involved (47). The different degrees of severity of the paronychia are illustrated in Figure 4.…”

Painful nails: A practical approach to the diagnosis and management of painful nail conditions

“…Onychalgia from drugs is mainly a side effect of some chemotherapeutic agents, although it may arise after prolonged courses of retinoids and tetracyclines [46][47][48] (Table 2). Nail side effects associated with taxoids (i.e., paclitaxel and docetaxel)…”

“…However, without the correct management, they can easily progress to significant pain and functional impairment, affecting the patient's quality of life. [46][47][48] The most debilitating taxoids-induced symptoms correspond to hemorrhagic onycholysis, subungual hematomas, and paronychia. 47,48 The pathophysiological origin of these nail abnormalities is not entirely understood.…”

“…[46][47][48] The most debilitating taxoids-induced symptoms correspond to hemorrhagic onycholysis, subungual hematomas, and paronychia. 47,48 The pathophysiological origin of these nail abnormalities is not entirely understood. A direct cytotoxic effect on the nail matrix and epithelial cells of the nail bed, in addition to an intrinsic antiangiogenic activity, have been proposed.…”

“…49 On the other hand, ingrown nails, acute paronychia, periungual abscesses, and pyogenic granuloma represent the leading causes of morbidity from anti-EGFR agents. 47,48 The pathogenesis of nail toxicity secondary to anti-EGFR agents remains unclear. It is presumed that growth disruption and apoptosis promotion of keratinocytes, as well as a proinflammatory microenvironment created through type 1 interferon, leads to tissue damage and nail plate and periungual skin fragility.…”