Nail changes during chemotherapy

Nail changes during chemotherapy

During chemotherapy treatment, you may notice changes to your fingernails and toenails. Most changes are temporary and not everyone is affected. Nails usually return to normal a few weeks after you finish chemotherapy.

If you experience severe changes or are worried, speak with your medical oncologist or nurse.

You can take steps to help reduce nail damage during chemotherapy.

What to expect

Common changes you may notice are:

• Nails become thin and brittle and break more easily.
• The colour changes, with what looks like black, brown or blue bruises under the nail.
• Lines, dents or ridges form along the nail, called ‘Beau’s lines’.
• Nails may crack or peel.
• The nail bed becomes dry.
• Nails feel more tender.
• Nails lift completely off the nail bed.

For some people, lines and ridges remain on their nails for some months. Nails will slowly grow back when you finish treatment.

Which chemotherapy drugs cause nail changes

Changes to fingernails and toenails are a side effect of some chemotherapy drugs. The main drugs that cause nail changes are:

• Taxanes such as Taxotere, Taxol, and Abraxane
• Anthracyclines such as Doxorubicin and Epirubicin
• Capecitabine (Xeloda).

Ways to care for your nails

There are a number of things you can do to reduce nail damage during chemotherapy.

• Use a nail-strengthening nail polish, such as Revitanail, which you can find in supermarkets or pharmacies.
• Use nail polish remover that is acetone-free.
• Keep your nails cut short.
• Moisturise your nails and cuticles regularly.
• Keep your hands and nails clean to avoid infection.
• Ensure you use a salon with good hygiene practices if you have a professional manicure or artificial nails.
• Protect your nails with gloves when gardening, using cleaning products, or working with your hands.
• If your nails split, use an antiseptic cream such as Savlon to reduce the risk of infection.
• Avoid tight shoes if your toenails are affected.
• Ask your treating team if you can take a multivitamin tablet, if you need to supplement your diet (always check before starting any new medication or supplement).

If these tips don’t help and you’re feeling distressed by skin or nail changes, talk to your oncology nurse or doctor.

Cooling gloves for chemotherapy

Some people wear cooling or ice gloves to prevent or minimise nail changes. These are like an icepack that you wear as gloves or mittens. You can also get cooling socks.

They are designed to keep your nails cold. You wear them before, during and after each chemotherapy session.

To use ice gloves effectively:

• Place your hands or feet in the frozen gloves at least 30 minutes before you start your chemotherapy session.
• Keep the gloves on for 30 minutes after your session is complete.
• If you want to, replace your gloves with a freshly chilled pair half-way through the session.

Frozen gloves don’t suit everybody. Some people find them quite painful, especially the first time they are used.

To help reduce or avoid any pain:

• Take the gloves out of the freezer around 10 minutes before you put them on.
• Wear thin cotton gloves underneath them.

Talk to your medical oncologist or oncology nurse if you are interested in frozen gloves.

Take care to avoid infection

If chemotherapy side effects cause changes to your nails, this may increase your risk of infection.

A nail infection can be serious if:

• your immune system is compromised by chemotherapy
• you have lymphoedema (fluid in the arms or hands as a result of breast cancer surgery).

It is important to tell your treating team immediately if you have signs of infection such as:

• redness
• heat
• swelling
• discharge
• pain.