Fact Sheet Chemotherapy and your nails Nails are prone to problems as a result of anticancer treatments. In fact, it is the second most important unanticipated side effect reported by patients. Nail problems can occur more often with certain types of medicines, especially taxane chemotherapies (paclitaxel and docetaxel) and many of the new biological treatments. Some of these side effects are a nuisance or affect the cosmetic appearance of the nail whereas others can be more severe and require treatment. Often daily activities are affected and many people say their quality of life is impacted. Nail changes are usually temporary and may improve after treatment is finished. However, because nails grow slowly, it may take months for them to return to normal. So it is ideal to prevent problems before they happen or as soon as they arise. An essential guide to looking after your nails during chemotherapy When nail folds are affected there is pain, redness and swelling. Skin infections (paronychia) around or under the nail can also occur. Sometimes, nail infections are first noticed when the skin around the nails becomes red and swells due to excess fluid. These infections can cause the affected nail to become sore and tender, making it difficult to to perform daily activities. Be sure to inform your healthcare team at the first signs of problems. In most people, nail changes caused by anti-cancer therapies begin within two or three months of starting treatment and improve within a few months afterwards. If you experience nail changes, it’s important to remember that they are a temporary, reversible reaction to your cancer treatment. Generally the nail goes back to normal. How anti-cancer treatments affect nails Part of nail affected Result Nail matrix Grooves, ridges, white lines and brittle nails Nail bed Brown or white discolouration, lifting or loss and infections (paronychia) Folds or cuticles Inflammation, infections, separation and pain Which anti-cancer medications may cause most nail problems? How nails are affected by treatments The type of nail changes depend on the medicine that is given and the duration of treatment. Some changes are mild and only affect the appearance of the nail while others can cause discomfort or pain. Nail brittleness is the most common side effect that can be caused by any chemotherapy or after stem cell transplants. If the nail matrix (see illustration above) is affected nails will be brittle and have grooves, ridges or discolouration which can be white or dark. Nail bed problems result in pain under the nail; red, purple, or green discolouration, with separation or lifting of the nail; and possibly even infections. Did you know: nail changes are the second most important unanticipated side effect reported by cancer survivors Although any chemotherapy can affect the nails, some of the biological therapies (cetuximab, erlotinib, lapatinib, panitumumab) as well as some conventional chemotherapies (paclitaxel and docetaxel) tend to cause more side effects in the nails. Studies show that about 80 percent of people taking docetaxel suffered from nail changes, with up to 30% having tenderness or infections that limited their daily activities. Tips for looking after your nails During and after your treatment, caring for your nails is very important. By following the tips below, you can reduce the impact of treatment on your nails. • Use clear nail polish to strengthen the nail and avoid nail products with harmful chemicals (like toluene or formaldehyde) For more information about the side effects of chemo and radiotherapy visit www.mosaiclife.co.uk" 1 • Dark nail polish can help if nails are discoloured. Try to use water based polishes, as they contain less harmful chemicals • Increase intake of dietary iron and reduce caffeine. Be sure to talk to your doctor before taking over-the-counter supplements or medications as these can interfere with cancer treatment • Avoid harsh soaps and detergents • Wear cotton socks to help absorb dampness which may avoid fungal nail infections and athlete's foot How do I know if my nails are infected? Signs of infection include redness, swelling and pain around the nails, sometimes with a discharge of foul-smelling fluid. About 30 to 50 percent of patients who receive treatments such as cetuximab, docetaxel, erlotinib, lapatinib, paclitaxel or panitumumab develop a skin infection around the nails, called paronychia. This infection usually begins two or three months after the start of treatment but can occur as late as 6 months afterward. Any fingernail or toenail can be affected and the infection needs to be treated, even if chemotherapy has finished. Although nail problems may be temporary, many patients who do suffer discomfort and restrictions to daily activities prefer to take action to prevent or treat their nail problems. There are now two new treatments available for nail problems called OnicoLife drops and OnicoLife gel. Recent studies show that patients experience complete relief of symptoms and pain within 30 days1. OnicoLife may help you too. How OnicoLife works Key to the effectiveness of OnicoLife is the fatty acid amide, Adelmidrol® which controls mast cell re-activity. Mast cells are immune cells which line the surfaces of the body including the skin. They play a significant role in causing inflammation and also in the wound healing process. By controlling the mast cells OnicoLife restores the capability of the skin and nails to respond to and repair the damage caused by chemotherapy. OnicoLife also contains many other constituents which support wound healing and the body’s natural antibacterial and anti-fungal action. OnicoLife Drops are for the treatment of tender and fragile nails for patients undergoing chemo or radiotherapy OnicoLife Gel is for the treatment of paronychia, a skin infection around the nails OnicoLife may also be useful for longitudinal nail ridges, split nails, yellowed nails and blackened nails What others are saying about OnicoLife "The gel and drops are amazing. My nails were hideous, totally shattered and every time I touched anything another bit of nail fell off. It felt as if my nails were exploding to pieces because of the chemotherapy. Since using OnicoLife every day for four weeks, the results have been really impressive. My nails look really healthy and the nail beds are shiny. I would happily show them off to anyone." PC, Wheathampstead, Herts Where can I get OnicoLife Drops and Gel? If you would like to know more about OnicoLife talk to your healthcare team. (As OnicoLife is a new treatment in the UK, some healthcare teams may not be familiar with OnicoLife so please take this patient information sheet with you). You can also buy OnicoLife on-line from the Mosaic Life website at www.mosaiclife.co.uk or ask your local pharmacist. 1De Marino E et al, Biological drugs: new challenge, new side effects on nails and skin appendages, Center for Oncology, University of Insubria, Ospedale di Circolo, Varese, Italy. Data on File For more information about the side effects of chemo and radiotherapy visit www.mosaiclife.co.uk" 2