Reactions 815 - 19 Aug 2000

Antineoplastics

Leuconychia: case reportA 21-year-old woman developed transverse leuconychia of

her fingernails after receiving antineoplastic therapy forHodgkin’s lymphoma.

The woman’s antineoplastic therapy consisted ofcyclophosphamide 650 mg/m2 on day 1, doxorubicin 25mg/m2 on day 1, etoposide phosphate 113.6 mg/m2 on days1–3, procarbazine 100 mg/m2 on days 1–7, prednisolone 80mg/m2 on days 1–7, vincristine 1.4 mg/m2 on day 8 andbleomycin 10 mg/m2 on day 8. As part of a pilot study, shereceived 8 courses of this regimen at 2-week intervals over a16-week period, with each course followed by radiotherapy;vincristine was omitted from the fifth course onwards due topolyneuropathy. She experienced other adverse effects duringantineoplastic therapy including amenorrhoea, reversible totalalopecia, oral mucositis and gastritis.

Two weeks after ending her antineoplastic therapy, thewoman had developed severe changes in her fingernails,including multiple transverse white striations across all herfingernails. These symptoms had initially appeared after herfirst course of antineoplastic therapy. She received treatmentwith oral biotin for 100 days, and retinol acetate, cystine andgelatine for two 3-week intervals. Her leuconychia graduallyimproved and had almost disappeared after 3 months’treatment. One year after antineoplastic therapy, she remainedin complete remission with a residual mediastinal abnormality.Her leuconychia resolved completely, but, during follow-up,she developed a split in her right thumbnail.

Author comment: ‘There are several arguments pointingtowards a causal relationship between the systemic applicationof chemotherapy and the appearance of leukonychia in ourpatient.’ Firstly, cytotoxic and antineoplastic agents canpotentially induce nail changes; secondly, there was a temporalrelationship between antineoplastic therapy and theappearance and resolution of leuconychia; and thirdly,cyclophosphamide-, doxorubicin- and vincristine-inducedleuconychia have all been described previously.Naumann R, et al. Transverse leukonychia following chemotherapy in a patientwith Hodgkin’s disease. European Journal of Dermatology 10: 392-394, Jul-Aug2000 - Germany 800837631

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Reactions 19 Aug 2000 No. 8150114-9954/10/0815-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved