ABSTRACT
Nail abnormalities frequently occur due to systemic drugs. Common drugs implicated include anticancer agents, antibiotics, retinoids, and antiretrovirals. Most nail changes due to drugs occur due to acute toxicity of the drug or their metabolites to the nail epithelia and thus they may involve many or all nails. Asymptomatic growth rate changes and pigmentation abnormalities are the most common drug-induced nail changes. The nail toxicities involving both the nail plate and bed present as leukonychia, melanonychia, onycholysis, Beau’s lines, onychomadesis, or onychorrhexis; whereas paronychia or pyogenic granuloma result due to involvement of the periungual area of the nail. Most of the nail changes are asymptomatic and gradually disappear on withdrawal of the offending drugs. However, pain and functional impairment are encountered at times, which affects the patient’s quality of life. This chapter reviews the nail changes induced by common systemic drugs in clinical practice. It is imperative to have an adequate knowledge of drug-induced nail changes so that unnecessary and overt investigations and treatment may be avoided.
