Common Nail Problems During Cancer Treatment

If you are in chemotherapy, you may notice your fingernails and toenails start to change. This is a common effect of many cancer treatments, along with skin changes and hair loss.

Some people in cancer treatment just don't like how their changing nails look. Other times, their nails also become painful and infected.

This article covers the changes you might expect, what you can do to ease your symptoms and cope, and when you should call your doctor.

Nail Symptoms From Chemotherapy

Chemotherapy can cause your nails to change in a few ways. Fingernails are affected more often than toenails.

Once your treatment is done, it can take about six to 12 months for your fingernails to grow back out to normal. Toenails can take longer—sometimes up to a year.

In some cases, nails never return to how they were before chemo.

Nail Weakness and Loss

Nails can grow weak and brittle during chemotherapy. They may also split from the tissue that holds nails in place (onycholysis). Less often, nails may fall off after several rounds of treatment.

Some chemotherapy medications, such as taxanes (Taxotere), are more likely to result in nail loss than others.

Beau’s Lines

Colorless ridges known as Beau’s lines may form on your nails. These ridges don't have any color, though they can appear lighter or darker than the rest of your nail. The ridges tend to be more horizontal than vertical.

Beau's lines themselves are harmless. Once your treatment is finished, the lines should grow out with the rest of your nail.

Koilonychia

Your nails may change shape, too. They may curve inward, forming a spoon-like shape. This is known as koilonychia.

Koilonychia is different than clubbing, a process associated with lung cancer in which the fingers can take on a permanent spoon shape.

Secondary Infections

A painful infection known as paronychia can form around your nail.

Your body needs white blood cells to fight infection. However, chemotherapy lowers your white blood cell count (chemotherapy-induced neutropenia).

If you get paronychia when your white blood cell count is low, your body could have a harder time fighting the infection. You may need to take an antibiotic or antifungal therapy to help your body fight it.

Effects of Specific Cancer Treatments

Some treatments are more likely than others to affect your nails. Certain drugs used in these treatments are more likely to cause problems too.

Chemotherapy Drugs

Chemotherapy drugs that tend to cause nail symptoms include:

• Taxanes such as paclitaxel and Taxotere (docetaxel)
• Anthracyclines such as Adriamycin (doxorubicin)
• 5-fluorouracil (5-FU)
• Capecitabine

If you are doing a taxane-based therapy, your oncologist may advise you to apply a hydrating nail solution once a day or as needed.

Studies show that hydrating nail solutions may reduce the risk of nail loss due to paclitaxel chemotherapy.

Targeted Therapies

The nail changes seen with targeted therapies differ from those seen with chemotherapy.

Nail infections that affect the nail folds (paronychia), as well as pyogenic granulomas around the nails (sores that grow fast and bleed easily), are most common.

Targeted therapies, especially EGFR inhibitors used to treat EGFR positive lung cancer, often cause nail problems.

Some drugs are more likely to cause nail problems than others, like Tarceva (erlotinib). MEK inhibitors and mTOR inhibitors can cause nail problems too, but it's less common.

Immunotherapy

The most common side effects of the immunotherapy drugs known as checkpoint inhibitors are conditions that end with “itis” (meaning inflammation) and can affect your skin and nails.

How to Save Your Nails During Chemo

Keep in mind that some cancer treatments can weaken your immune system. So if you get a nail infection, make sure to tell your oncologist. The quicker you get the infection treated, the less likely it is to damage your nails.

If you have a collection of pus starting to form, you may need to see a dermatologist for an incision and drainage procedure.

Self-Care

Things you can do to manage your symptoms and help prevent more problems include:

• Keep all your nails trimmed. Ideally, toenails should be cut short and straight across.
• Wear gloves when working. Cotton gloves can protect your hands during gardening. Use rubber gloves when cleaning or washing dishes to keep your hands from drying out.
• Don’t bite your nails, as this increases the risk of infection. Wear cotton gloves if it's tough for you to break the habit.
• Avoid manicures, pedicures, fake nails, and cutting your cuticles. These can increase your risk of infection. If you do get a mani/pedi, bring your own supplies.
• In general, it is best to avoid nail polish. That said, some people find that using clear polish helps strengthen and may protect their nails.
• Some people find that soaking their hands in natural oils, such as olive oil, is helpful.
• Wear comfortable, roomy shoes that your toenails won't rub against.
• If one of your nails is loose, do not pull it off. Lightly cover it with a bandage or gauze (to avoid accidentally ripping off your nail) and let it fall off on its own.

Prevention

Some studies suggest that cooling hands and nails during chemo might reduce nail damage. Some cancer centers provide ice packs that people can use.

Nail changes, however, can’t be prevented completely. Applying ice to your hands during chemo can also be uncomfortable.

A 2018 study found that applying a solution called “PolyBalm” to nails during chemotherapy greatly reduced nail damage and loss. PolyBalm is a natural herbal oil. If you will be receiving a taxane drug during chemotherapy, ask your doctor about this option or other creams that may reduce nail symptoms.

Summary

Many people are aware of the skin and hair changes that come with getting cancer treatment. But it's also common for your nails to be affected. Chemotherapy, immunotherapy, and other cancer treatments can affect the strength, color, and shape of your nails. Infection around your nails can also occur.

Talk to your doctor about ways to prevent nail changes and ease nail symptoms while you're going through cancer treatment. If you notice any signs of infection, make sure to let your doctor know.

A Word From Verywell

You may not be able to prevent nail changes completely. That said, prevention is still the best treatment. You can start protecting your nails from the effects of cancer treatment before problems begin. By caring for your nails, you can also reduce your risk of infection. Make sure you know the signs of infection so that if you develop one, you can let your doctor know before it gets serious.