Docetaxel and paclitaxel comprise of the two main taxanes in clinical use. Docetaxel is a semisynthetic taxoid derived from the needles of Taxus baccata (the European yew). The taxanes are structurally similar and the mode of action of both drugs involves binding to the (5-subunit of tubulin in mitotic spindles, to form unstable microtubule aggregates, which lead to blockade of the cell cycle. The two drugs differ in the specific cell cycle phase affected. Docetaxel arrests cells in the S phase, whereas paclitaxel inhibits cells in the G2-M phase junction.
Common dose-limiting side-effects of both drugs include neutropenia and oral mucositis, and peripheral neuropathy occurs in one third of patients.
Cutaneous reactions to taxanes include maculopa- pular exanthems, urticaria, erythematous plaques, acral erythrodysesthesia and desquamation. Alopecia occurs in nearly all the patients.
Nail changes are a common and well-known side effect of many antineoplastic drugs, especially methotrexate, 5-fluorouracil, mitoxantrone, etoposide, doxorubicin, ixabepilone, and capecitabine. viagra plus
Taxanes might be included in the chemothera- peutic drugs that frequently produce nail changes such as onycholysis, onychomadesis and hemorrhage. Nail changes related to docetaxel have been reported in 30-40% of patients, compared with 2% due to the use of paclitaxel? Nail bed purpura often precedes onycholysis. ‘Hemorrhagic onycholysis’ refers to the combination of onycholysis and subungual discharge of hemopurulent exudate.
Taxane-induced onycholysis is a consequence of toxic, direct damage to the nail bed epithelium leading to epidermolysis, loss of nail-bed nail-plate adhesion, and formation of a hemorrhagic bulla. The possible explanations for subungual hematoma and hemorrhagic onycholysis are the taxane-induced thrombocytopenia and vascular abnormalities.
The mean onset of nail changes evoked by chemotherapeuticals is 12 weeks from the initiation of therapy? The development of onycholysis seems to be unrelated to the drug dose or frequency of administration. Chemotherapy-related immunosuppression presumably increases the potential for secondary bacterial infection, including abscess formation.
Nail abnormalities occurring during taxane treatments are, in most cases, not serious and do not usually warrant the discontinuation of treatment. But, hemorrhagic onycholysis and subungual abscesses are quite exclusive of taxane therapy. These side effects can cause severe complications enhancing the risk of sepsis, since patients may become neutropenic during chemotherapy.
Premedications with steroid minimize the development of fluid-retention syndrome and acute hypersensitivity related to chemotherapy, but do not seem to protect against cutaneous adverse effects. Recently, Scotte, et al. reported that a frozen glove significantly reduces the nail and skin toxicity associated with docetaxel. They extended the concept that cold temperature applied to the scalp during chemotherapy reduces the incidence of chemotherapy-induced alopecia. Onycholysis and skin toxicity were significantly lower in the frozen glove-protected hand compared with the control hand. Antibiotics or antifungal treatments may be required to treat nail bed infections. canada drugs online
We report a case in which severe nail toxicity related to taxanes led to discontinuation of chemotherapy. We suggest that clinicians should be aware of the spectrum of taxane-induced nail toxicity.