Tuberc Respir Dis.  2007 Feb;62(2):125-128. 10.4046/trd.2007.62.2.125.

A Case of Subungal Abscess and Onycholysis Induced by Docetaxel

• Jung HY
• Lee CY
• Kim HJ
• Ahn CM
• Chang YS

• KMID: 2114599
• DOI: http://doi.org/10.4046/trd.2007.62.2.125

Abstract

Docetaxel is a taxoid antineoplastic drug, which is widely used to treat locally advanced or metastatic non-small cell lung cancer (NSCLC). Among the adverse dermatological reactions, nail disorders such as bending, onycholysis, hypo- or hyperpigmentation are rare. We report a case of a 62-year-old male with advanced NSCLC (cT4N3M1, stage IV), who developed purulent discharge and onycholysis in the nail of all his fingers and the left great toe after five courses of anti-neoplastic chemotherapy, which included docetaxel (cumulative dose: 370 mg/m2, 590 mg). Seven days after the final session of chemotherapy, the patient had become aware of discoloration and swelling of the nail beds with out pain. Three days later, greenish-yellow purulent discharge oozed out from the involved nails. Microbiologic studies revealed Pseudomonas aeruginosa. Intravenous and topical antibiotics (mupirocin) were applied. After 2 weeks, regrown nails were observed and the onycholysis had improved.

Keyword

Docetaxel; Onycholysis; Subungal abscess

MeSH Terms

Abscess*
Anti-Bacterial Agents
Carcinoma, Non-Small-Cell Lung
Drug Therapy
Fingers
Humans
Hyperpigmentation
Male
Middle Aged
Onycholysis*
Pseudomonas aeruginosa
Toes
Anti-Bacterial Agents

Figure

• 

  Figure 1 Computed tomography shows mass lesion in the lower lobe of left lung

• 

  Figure 2 After 5th chemotherapy, computed tomography shows marked resolution of primary tumor in the ekf

• 

  Figure 3 At initial admission, all finger nails showed subungal abscess and onycholysis induced by docetaxel.

• 

  Figure 4 All finger nails showed improvement after 14-days antibiotic treatment.

Reference

1. Miller VA, Krug LM, Ng KK, Pizzo B, Perez W, Heelan RT, et al. Phase II trial of docetaxel and vinorelbine in patients with advanced non-small-cell lung cancer. J Clin Oncol. 2000. 18:1346–1350.

2. Janinis J, Papadakou M, Panagos G, Panousaki A, Georgoulias V, Hatzidaki D, et al. Sequential chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil in patients with locally advanced head and neck cancer. Am J Clin Oncol. 2001. 24:227–231.

3. Tinio P, Bershad S, Levitt JO. Docetaxel-induced onycholysis. J Am Acad Dermatol. 2005. 52:350–351.

4. Obermair A, Binder M, Barrada M, Bancher-Todesca D, Asseryanis E, Kubista E. Onycholysis in patients treated with docetaxel. Ann Oncol. 1998. 9:230–231.

5. Almagro M, Pozo JD, Garcia J, Vasquez A, Fonseca E. Nail alterations secondary to paclitaxel therapy. Eur J Dermatol. 2000. 10:146–147.

6. Moisidis C, Mobus V. Erythema multiforme major following docetaxel. Arch Gynecol Obstet. 2005. 271:267–269.

7. Minisini AM, Tosti A, Sobrero AF, Mansutti M, Piraccini BM, Sacco C, et al. Taxane-induced nail changes: incidence, clinical presentation and outcome. Ann Oncol. 2003. 14:333–337.

8. Correia O, Azevedo C, Pinto Ferreira E, Braga Cruz F, Polonia J. Nail changes secondary to docetaxel (Taxotere). Dermatology. 1999. 198:288–290.

9. Vanhooteghem O, Andre J, Vindevoghel A, Vandenbossche L, Vandeveire A, Song M. Docetaxel-induced subungal hemorrhage. Dermatology. 1997. 194:419–420.

10. Lee MS, Kim HO, Park YM. A case of subungal abscess and onycholysis related to docetaxel. Korean J Dermatol. 2003. 41:1393–1395.

11. Nicolopoulos J, Howard A. Docetaxel-induced nail dystrophy. Australas J Dermatol. 2002. 43:293–296.

12. Wasner G, Hilpert F, Schattschneider J, Binder A, Pfisterer J, Baron R. Docetaxel-induced nail changes: a neurogenic mechanism: a case report. J Neurooncol. 2002. 58:167–174.

13. Jones R, Ryan M, Friedlander M. Carboplatin hypersensitivity reactions: retreatment with cisplatin desensitisation. Gynecol Oncol. 2003. 89:112–115.

14. Scotte F, Tourani JM, Banu E, Peyromaure M, Levy E, Marsan S, et al. Multicenter study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity of the hand. J Clin Oncol. 2005. 23:4424–4429.