Advances in Drug-Associated Nail Toxicity
ZHOU Zichen
WANG Daguang
Abstract：Drug-associated nail toxicity refers to a spectrum of adverse effects on the nail unit caused directly or indirectly by a variety of medications.Clinical presentations are heterogeneous and include nail discoloration,dystrophic changes,nail-fold injury,and vascular compromise.Discoloration manifests as melanonychia(black/brown nails),xanthonychia(yellow nails),blue nails,or leukonychia(white nails),and is commonly linked to tetracyclines,retinoids,antimalarials,and cytotoxic chemotherapy.Nail dystrophy,which manifests as thinning,brittleness,Beau's lines,or onychomadesis,occurs most often with chemotherapeutic agents,retinoids,and anticoagulants.Paronychia and pyogenic granuloma are frequently reported with targeted therapies,while vascular nail injuries are associated with anticoagulants and vasoconstrictive agents.Antineoplastic drugs are the predominant culprits,though antifungals,immunosuppressants,and other drug classes have also been implicated.Management emphasizes early recognition and tailored intervention:Symptomatic care,strict skin and nail hygiene,photoprotection when relevant,topical/systemic antimicrobial therapy for secondary infection,cooling strategies,and consideration of dose modification or drug cessation when necessary.Prophylactic and intra-infusion measures,such as frozen gloves,hilotherapy,and ice-pack application,have been shown to reduce the incidence of taxane-related nail toxicity.Clinicians should integrate the offending drug class and the characteristic pattern of nail involvement to initiate prompt preventive and therapeutic measures,thereby alleviating symptoms and preserving patients'quality of life.
Keywords：nail taxieitydrug-relatedmelanonychianail dystrophyonycholysisparonychia
Publication Date：2026-02-10
Online Publishing Date：2026-03-17(First online date of this platform, not the publication date of the document)
Pages：5( 46-50 )