Nail and Skin Pigmentation:
Adverse Effects of Docetaxel
Case History
A 50-year-old female presented with carcinoma of the breast with pulmonary metastasis. She was given docetaxel 40 mg/ m 2 weekly for palliation since her tumour was oestrogen and progesterone receptor-negative. After 4 weeks of treatment with docetaxel, the patient noticed skin pigmentation around her nails in both upper and lower limbs. Two weeks later, pigmentation of the nails appeared (Figures 1 and 2). Docetaxel was stopped after 6 weeks of treatment. Subsequently the nail and skin pigmentation recovered after 2 months.
Discussion
Taxanes are newer chemotherapeutic agents that act via stabilising microtubules and inducing G2/M phase cell cycle arrest.1 Skin and nail changes are one of the common non-haematological toxicities associated with docetaxel.2 Nail changes include dark pigmentation, Beau's lines, subungual haemorrhage, orange discoloration, acute painful paronychia, and onycholysis. These changes are seen in 30% to 40% of patients receiving docetaxel and the severity is related to the number of cycles. There is no way to prevent these changes.2,3 Onycholysis is an uncommon effect of taxol but it has been documented with higher dose regimens.4 Inhibition of angio-genesis has been proposed as mechanism for this effect. Skin toxicities are common with docetaxel . Erythematous pruritic maculopapular rashes affecting the forearm and hand occur in 50% to 75% of patients. Superficial desquamation of the hands and feet have been observed. Alopecia occurs in most patients.1,5 Docetaxel-induced palmoplantar erythrodysesthesia responds to pyridoxine and cooling.6,7 Clinicians should be aware of these complications and be prepared to advise patients who develop signs and symptoms of nail and skin changes. Chemotherapy is usually continued for patients with nail and skin changes.
| Figure 1. Bilateral hands showing nail changes. |
Figure 2. Bilateral feet showing nail changes. |
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References
- Cortes JE, Pazdur R. Docetaxel. J Clin Oncol 1985;13:2643-2655.
- Correa O, Azevedo C, Pinto Ferreira E, Brega F, Polania J. Nail changes secondary to docetaxel. Dermatology 1999;198:288-290.
- Lombart-Cussae A, Pivot X, Spielmann M. Docetaxel chemo-therapy induces transverse superficial loss of nail plate. Arch Dematol 1997;133:1466-1467.
- Flory SM, Solimando DA Jr, Welster GF, Dunton CT, Neufeld JM, Hoffey MB. Onycholysis associated and weekly administration of paclitaxel. Ann Pharmacother 1999;33:584-586.
- Schijvers D, Wanders J, Dirix L, et al. Coping with toxicities of docetaxel. Ann Oncol 1993;4:610-611
- Vukelja SJ, Baker WJ, Burris HA, et al. Pyridoxine therapy for palmar planter erythrodysesthesia associated with taxotere. J Natl Cancer Inst 1993;85:1432-1433
- Zimmerman GC, Keeling JH, Lowry M, et al. Prevention of docetaxel induced erythrodysesthesia with local hypothermia. J Natl Cancer Inst 1994;86:557-558.
Dr PP Bapsy
Dr K Prabhash
Dr C Haritha
Dr KG Babu
Department of Medical Oncology
Kidwai Memorial Institute of Oncology
Bangalore, India
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