Abstract
This article reviews the different nail symptoms produced by drugs. Drug-induced nail abnormalities may result from toxicity to the matrix, the nail bed or the periungual tissues. The most common symptoms include Beau’s lines/onychomadesis, melanonychia, onycholysis, and periungual pyogenic granulomas. Nail changes usually affect several nails and in most cases are asymptomatic. Drugs that most frequently produce nail abnormalities include retinoids, indinavir, and cancer chemotherapeutic agents. In this article, we also include nail adverse effects as a result of radiotherapy since they are commonly observed in clinical practice.
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Tosti A., Baran R., Dawber R.P.R. The nail in systemic diseases and drug-induced changes. In: Baran R., Dawber R.P.R., de Berker D.A.R., et al., editors. Baran and Dawber’s diseases of the nails and their management. 2nd ed. Oxford: Blackwell Science, 2001: 223–329
Piraccini B.M., Tosti A. Drug-induced nail disorders: incidence, management and prognosis. Drug Saf 1999 Sep; 21 (3): 187–201
Daniel III C.R., Scher R.K. Nail changes secondary to systemic drugs or ingestans. J Am Acad Dermatol 1984 Feb; 10 (2): 250–258
Daniel III C.R., Scher R.K. Nail changes secondary to systemic drugs and ingestans. In: Sher R.K., Daniel III C.R. Nails: therapy, diagnosis, surgery. Philadelphia (PA): WB Saunders Company, 1997: 251–275
Baran R. Retinoids and the nail. J Dermatol Treat 1990; 1: 151–154
Baran R., Kechijian P. Longitudinal melanonychia: diagnosis and management. J Am Acad Dermatol 1989 Dec; 21 (6): 1165–1175
Vanhooteghem O., Richert B., Vindevoghel A., et al. Subungual abscess: an ungual side-effect related to docetaxel therapy. Br J Dermatol 2000 Aug; 43 (2): 445–473
Hussain S., Anderson D.N., Salvatti M.E., et al. Onycholysis as a complication of systemic chemotherapy: report of five cases associated with prolonged weekly paclitaxel therapy and review of the literature. Cancer 2000 May; 88 (10): 2367–2371
Varotti C., Ghetti E., Piraccini B.M., et al. Subungual hematoma in a patient treated with an oral anticoagulant (warfarin sodium). Eur J Dermatol 1997; 7 (5): 395–396
Baran R. Etretinate and the nails (study of 130 cases): possible mechanisms of some side effects. Clin Exp Dermatol 1986; 11: 148–152
Bouscarat F., Bouchard C., Bouhour D. Paronychia and pyogenic granuloma of the great toes in patients with indinavir. N Engl J Med 1998 Jun; 338 (24): 1776–1777
Calista D., Boschini A. Cutaneous side effects induced by indinavir. Eur J Dermatol 2000 Jun; 10 (4): 292–296
Tosti A., Piraccini B.M., D’Antuono A., et al. Paronychia associated with antiretroviral therapy. Br J Dermatol 1999 May; 140 (5): 1165–1168
Stringer M.D., Bentley P.G. Peripheral gangrene associated with ß-blockade. Br J Surg 1986; 73: 1008–1011
Behrens S., Reuther T., Von Kobyletzki G., et al. Bleomycin induzierte PSS-artige pseudokeerodermie. Hautarzt 1998; 49: 725–729
Wolf R., Tur E., Brenner S. Corticosteroid-induced “disappearing digit”. J Am Acad Dermatol 1990 Oct; 23 (4 Pt 1): 755–756
Holmes L.B., Harvey E.A., Brown K.S., et al. Anti-convulsant teratogenesis I: a study design for newborn infants. Teratology 1994; 49: 202–207
Pichini S., Altieri I., Zuccaro P., et al. Drug monitoring in non conventional biological fluids and matrices. Clin Pharmacokinet 1996 May–Jun; 30 (3): 221–228
Lemos N.P., Anderson R.A., Robertson J.R. Nail analysis for drugs of abuse: extraction and determination of cannabis in fingernails by RIA and GC-MS. J Anal Toxicol 1999 Mar; 23 (3): 147–152
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Piraccini, B.M., Iorizzo, M. & Tosti, A. Drug-Induced Nail Abnormalities. Am J Clin Dermatol 4, 31–37 (2003). https://doi.org/10.2165/00128071-200304010-00004
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DOI: https://doi.org/10.2165/00128071-200304010-00004