Nail changes due to chemotherapy: a prospective observational study of 129 patients.

BACKGROUND: Nail changes due to systemic drugs are common, especially with anticancer treatments due to involvement of nail plate, nail bed and periungual area. OBJECTIVE: To study the pattern of nail changes occurring due to chemotherapy in patients suffering from various malignancies. MATERIALS AND METHODS: A prospective, observational study was conducted at various health care centres, Nashik, India, for 15 months. The timing of administration of chemotherapy and onset of nail changes were recorded and evaluated by a dermatologist at regular interval. RESULTS: A total of 129 diagnosed cases of various malignancies who received chemotherapy were included. The most common malignancy noted was breast cancer, that is n = 42 (32.5%) followed by oral cancer, that is n = 24 (18.6%). Chemotherapy agents included taxanes (n = 54), cyclophosphamide (n = 42) and prednisolone (n = 28). Nail changes were noted in 92 patients (71.3%). The most common nail changes observed were chromonychia (n = 70, 54.26%), followed by nail dystrophy (n = 38, 29.45%). CONCLUSION: Nail toxicity is quite common side effect of anticancer agents. Nail changes due to chemotherapy depend on the nail structure involved and the severity of insult. Awareness among dermatologists and oncologists of these nail changes and their culprit agent can promote early diagnosis and may avoid inadvertent measures.

Abnormal fingernail beds following carbon monoxide poisoning: a case report and review of the literature.

INTRODUCTION: Carbon monoxide poisoning is a very common cause of death in accidental, suicidal, or homicidal cases throughout the world. Fingernail bed manifestation is reported in survivors of carbon monoxide poisoning. CASE PRESENTATION: A 40-year-old Caucasian woman was exposed to carbon monoxide when she was sleeping alone in her one-bedroom apartment; fortunately, the beeps from her First Alert combination smoke and carbon monoxide detector woke her and she was saved from any extensive health issues. The most indicative symptoms experienced were a severe headache, blurred vision, agitation, and confusion. Following contact with the Emergency Responses Services, she was promptly transferred to the hospital via ambulance and was treated with high-flow oxygen on the way. She was discharged from the emergency department on the same day, but carbon monoxide exposure had already had adverse effects on her fingernail beds. The fingernail tips were altered and appeared as if a bite had been taken out of their distal borders. The changes in the tips of her fingernails were significant, but they completely disappeared eight weeks later without any additional treatment. CONCLUSIONS: Worldwide, carbon monoxide poisoning is a potentially lethal condition that is preventable with educational programs and installation of carbon monoxide detectors in the home setting. Exposure to carbon monoxide frequently goes unrecognized until it is too late and causes silent death. To the best of the authors' knowledge, this is the first report in the literature of fingernail bed manifestations in a survivor of carbon monoxide poisoning.

Doxorubicin-induced hyperpigmentation.

A 39-year-old man with human immunodeficiency virus infection and Kaposi sarcoma on HAART therapy and doxorubicin presented in 2007 with a hyperpigmented tongue. Physical examination also showed hyperpigmented patches on the mucosal aspects of the lips and longitudinal dark bands on multiple nails. A skin biopsy specimen showed pigmentary alteration. Such hyperpigmentation has been described in numerous case reports and case series and has been reported to resolve within weeks to months of cessation of doxorubicin.

Reduced expression of von Hippel-Lindau gene in subjects exposed to polychlorinated biphenyls and dibenzofurans.

Polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs) are ubiquitous pollutants found in the environment and human tissues. A cohort in Taiwan has undergone follow-up for 24 years after exposure to high levels of PCBs and PCDFs. The incidence of chloracne, hyperkeratosis, and abnormal nail was increased among exposed people. We conducted a study to identify the genes whose expressions were affected by such exposure. A cDNA microarray system consisting of 908 genes was used for pooled serum samples from non-smoking men exposed to PCBs and PCDFs (n=15) and their matched referents (n=15) in triplicate. After adjusting for background and housekeeping genes, genes with different expressions between the exposure and reference groups were determined by both regression and cluster analysis, and further confirmed by real-time RT-PCR. The tumor suppressor gene von Hippel-Lindau (VHL) was found to be down-regulated in the microarray analysis. VHL gene expression levels were also found to be positively associated with age, shown by real-time RT-PCR. Upon age adjustment, VHL gene expression was reduced in Yucheng ("oil disease") subjects as compared to referents. Among Yucheng people, those with abnormal nails had lower VHL expressions than those without abnormal nails. These findings provide new insights into the potential role of VHL in health conditions associated with PCB and PCDF exposures.