International Journal of Clinical Case Reports 2015, Vol.5, No. 40, 1-3
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anti neoplastic agent in colon, gastric and breast
cancers. Compared to 5FU which needs prolonged
infusion capecitabine has the advantages of oral
administration. The frequent side effects observed
with capecitabine have been diarrhea, fatigue, hand
foot syndrome (HFS) and hematologic side effects.
HFS is seen in approximately 50% patients. Other
uncommon dermatologic manifestations include
dermatitis, stomatitis and nail changes. Capecitabine
induced nail changes have been reported scarcely in
literature (Chen et al., 2001; Piguet and Borradori,
2002; Maino et al., 2003).
Chemotherapy induced nail changes include hyperpi-
gmentation, Beau’s lines, nail loss, onychodystrophy,
edema and onycholysis (Susser et al., 1999). A
number of chemotherapy agents commonly used in
breast, gastric, colon and testicular cancer like bleomycin,
etoposide, 5 fluorouracil, docetaxel, doxorubicin and
cyclophosphamide have been implicated in causing
onycholysis (Susser et al., 1999). The etiology is
supposed to be chemotherapy induced immunosupp-
ression and subsequent colonization of the nail bed
leading to changes in the nail plate like thinning, sub
ungula edema and lifting of the nail plate off the nail
bed, effects of chemotherapy on vasculature and
changes in the cellular matrix (Chen et al., 2003). The
nail toxicity seen in our patient was mostly due to
direct nail toxicity and subsequent infection. The
onycholysis observed in these patients has a sunset
appearance; hence it is called sunset onycholysis
(Vaccaro et al., 2008). Other nail changes observed
with capecitabine may include onychomadesis,
hyperkeratosis and paronychia (Maino et al., 2003).
Reference
Chen G.Y., Chang T.W., and Chen W.C., 2003, Exudative hyponychial
dermatitis associated with capecitabine and docetaxel combination
chemotherapy for metastatic breast carcinoma: report of three cases, Br.
J. Dermatol, 148: 1071-1073
Chen G.Y., Chen Y.H., Hsu M.M., Tsao C.J., and Chen W.C., 2001,
Onychomadesis and onycholysis associated with capecitabine, Br. J.
Dermatol, 145: 521-522
Maino K.L., Norwood C., and Stashower M.E., 2003, Onycholysis with the
appearance of a “sunset” secondary to capecitabine, Cutis, 72: 234-236
Piguet V., and Borradori L., 2002, Pyogenic granuloma-like lesions during
capecitabine therapy, Br. J. Dermatol, 147: 1270-1272
Susser W., Whitaker-Worth D., and Grant-Kels J., 1999, Mucocutaneous
reactions to chemotherapy, J. Am. Acad. Dermatol, 40: 367-398
Vaccaro M., Barbuzza O., Guarneri F., and Guarneri B., 2008, Nail and
periungual toxicity following capecitabine therapy, Br. J. Clin.
Pharmacol, 66: 325-326
