ABSTRACT
Chemotherapeutic medications, such as taxanes, bruton tyrosine kinase inhibitors and BRAF inhibitors, and epidermal growth factor receptor inhibitors can alter production of nail plates and thus cause nail thinning and brittleness. Chemotherapeutic agents most often associated with nail matrix damage include taxanes, cisplatin, melphalan, and vincristine. Medications that impair the mitotic activity of the keratinocytes located in the distal nail matrix cause parakeratosis of the ventral nail plate with transverse leukonychia. Melanonychia is a black or brown longitudinal or transverse pigmentation of the nail plate due to production of melanin pigment from activated melanocytes in nail matrix. Paronychia tends to regress with dose reduction or discontinuation of medications, however, treatment can include proper nail hygiene and protection, antiseptic washes, and topical corticosteroids to help decrease inflammation. Subungual hemorrhage, presenting as splinter hemorrhages and subungual hematomas of the nail unit, are produced from damage of the nail unit caused by alterations in the nail bed blood flow.
