Nail Changes

Common nail changes during cancer treatment

How your nails change during cancer treatment depends on what is causing the changes. Different treatments are more likely to cause certain types of changes. Depending on your treatment, you might notice changes in how your nails look or feel. You might also notice changes around or under your nails.

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Common nail changes caused by cancer treatment include:

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Weaker nails: Nail thinning or reduced strength, leading to breakage
Painful nailbeds: Delicate, sensitive nailbeds or cuticles
Dry or cracked skin: Around your nails or cuticles
Color changes: Yellowing, discoloration, or over-pigmentation on your nails or nailbeds
Irregular marks: Ridges, pits, spots, or splitting of nails
Muehrcke lines: Pairs of white lines across the nails that move as your nail grows out
Mees’ lines: Horizontal white line (usually only one) across the nails that doesn’t move as your nail grows out
Beau’s lines: Horizontal ridges or grooves on nails
Nail plate issues: Nail lifting or falling off (known as onycholysis)
Growth problems: Slower growth than normal, or no growth at all
Infections: Nail infections (known as paronychia), more common if nails are cracked or open

All of these changes can also be caused by non-cancer conditions, treatments, and medicines. It’s important to tell your health care team if you have any nail symptoms, even if they aren’t painful or bothering you.

What cancer treatments cause nail changes?

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Some types of chemotherapy, immunotherapy, and targeted drug therapy can cause damage or changes to your nails. One, two, a few, or all of your nails could be affected.

Nail changes from chemo usually start sooner than changes caused by immunotherapy and targeted drug therapy. Most nail changes are temporary, but some can last long after treatment ends or can even be permanent.

Chemotherapy

Nail changes caused by chemo are usually short-term and return to normal within a few months of stopping treatment.

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These types of chemo are more likely to cause nail changes:

Vincristine (Oncovin, Vincasar PFS)
Paclitaxel (Taxol)
Fluorouracil (5FU, Carac)
Etoposide (Vepesid, VP-16)
Daunorubicin (Cerubidine)
Bleomycin (Bleonoxane)
Cyclophosphamide (Cytoxan)
Dacarbazine (DTIC-Dome)
Methotrexate (Otrexup, Rasuvo, RediTrex, Trexall, Xatmep)

Immunotherapy

Most nail changes from immunotherapy are caused by immune checkpoint inhibitors. Monoclonal antibodies are another type of immunotherapy that can cause nail changes, but this is less common.

Targeted drug therapy

Most nail changes from targeted drug therapy are caused by EGFR inhibitors. VEGF (or angiogenesis inhibitors) are another type of targeted drug therapy that can also cause nail changes.