Evaluation of relationship between clinical and dermoscopic nail changes and chemotherapy drugs in oncologic patients

Aim: Since there are only a few studies dealing with dermoscopic examination of chemotherapy-induced nail changes, this study was done to determine more comprehensively the place of dermoscopy in the diagnosis and management of such changes. Materials and methods: Of 227 patients (115 males and 112 females, aged 20 to 88 years) who were taking chemotherapy at the Oncology Outpatient Clinic of Çukurova University, only fingernails were examined both clinically and dermoscopically. The following variables were analyzed as risk factors for nail changes using multivariate logistic regression: age, sex, cancer type, cancer duration, presence of systemic diseases affecting nails, and groups of chemotherapeutics. Results: The most common cancer types were breast (25,6%), lung (21,6%), colon (14,5%), and hematologic cancers (8,4%). Of the patients, 49,3% had suffered from cancer for periods shorter than nine months; and the rest, for longer periods. Systemic diseases affecting nails were present in 14,5% of patients. The most commonly used groups of chemotherapeutics were corticosteroids (62,6%), platins (50,2%), targeted therapies (41,0%), and taxanes (31,3%). The most common nail changes were longitudinal ridging (45,4%), onycholysis (37,0%), splinter hemorrhage (37,0%), longitudinal melanonychia (26,4%), leukonychia (23,3%), red lunula (15,9%), and transverse melanonychia (13,7%). Only three of them were significantly associated with some variables in multivariate logistic regression analysis. Transverse melanonychia was more common in patients using taxanes (odds ratio [OR] 9,458, 95% confidence interval [CI] 1,938 to 46,151, p≈0,005). Both onycholysis and longitudinal ridging positively associated with age (OR 1,052, 95% CI 1,021 to 1,085, p≈0,001 and OR 1,068, 95% CI 1,034 to 1,103, p<0,001, respectively). Conclusion: In this study, longitudinal ridging, onycholysis, splinter hemorrhage and red lunula were more commonly observed as compared to other studies investigating chemotherapy-induced nail changes. This study's higher rates for these changes, particularly for splinter hemorrhage, could be explained by that dermoscopy was used in this study, but did not in other studies. In the light of the fact that both splinter hemorrhage and melanonychia are early findings of nail toxicity caused by chemotherapeutics including taxanes, it is recommended that nails of patients under chemotherapy should be periodically examined by dermoscopy from the beginning of chemotherapy in order to detect nail toxicity before its advanced stages have developed.