During treatment for cancer, you or your loved one may notice some changes in the appearance of the finger or toenails. Whilst nail issues are not usually a serious side effect of chemotherapy, they can nevertheless be annoying and painful. Plus nail damage, such as hang nails, torn cuticles or lost nails can allow bacteria in, which could lead to infection, which can be serious if the immune system is compromised from chemotherapy. So it's important to take good care of your nails before, during and after chemotherapy treatment.
Not all people will experience nail changes, but they are frequent, reportedly occurring in up to 44% of patients undergoing treatment with taxane drugs and 10-15% of patients undergoing treatment with epidermal growth factor receptor inhibitors.
Possible nail changes due to chemotherapy
Nails can become weak and brittle during chemotherapy treatment and are likely to break more easily. They may even peel or split. In general, nails will not grow as quickly or as long as they used to.
You may notice a line or indentation (Beau’s line) in the nail related to the cycle of chemotherapy. There may even be multiple lines and indentations reflecting the different cycles of chemotherapy. Beau’s lines tend to appear when growth at the area under the cuticle is interrupted by injury or severe illness.
Nails may also become discoloured or pigmented – they may take on a dirty yellow or brownish hue or they may look bruised, turning black, blue or green.
The nail bed may become dry and you may have frayed cuticles. Nails can feel like they hurt or feel loose. Occasionally the nail can lift completely off the nail bed or in some cases after several rounds of treatment, can fall off completely, although this is less common. Some chemotherapy medications such as taxanes (Taxol and Taxotere) are more likely to result in nail loss than others.
The image below shows what nail damage might look like as a result of chemotherapy treatment.
A. Panoramic view of fingernails due to docetaxel female breast cancer.
B. Close up of nail lesions onycholysis and Beau´s lines due to docetaxel female breast cancer.
C and D. Clinical and dermatoscopic nail changes due to docetaxel female breast cancer.
Fingernails tend to be affected more than toenails and nails usually grow out normally again roughly six months after finishing treatment. Interestingly, fingernails grow about 2-3 times faster than toenails, with fingernails taking an average of six months to grow out and toenails taking up to a year, although some people tell us that ridges and lines have remained on their nails for longer.
9 tips to help protect nails during chemotherapy
1. Keep fingernails and toenails short to reduce the risk of breaking. If nails are brittle or weak it is advisable to file them with a soft nail file rather than using scissors or a nail clipper. Glass nail files tend to be gentler than traditional nail files. Smooth jagged edges and remove any hangnails promptly to avoid catching on something that could tear it off.
2. Don't bite nails as this increases the risk of infection. Try wearing cotton gloves if having difficulty breaking the habit.
3. Cuticles protect nails from infection so don’t pick at or cut cuticles, use a cuticle balm to soften and nourish them and push them back gently using a wooden cuticle stick.
4. Wear gloves when doing any housework or gardening to reduce the risk of infection. Avoid any prolonged contact with detergent and water when cleaning or washing dishes to prevent nails from drying out further.
5. Keep hands and nails clean to avoid infection.
6. Wear comfortable, loose-fitting shoes to minimise trauma to your toenails.
7. Moisturise, moisturise, moisturise – your nails absorb water a hundred times faster than your skin and they lose moisture just as readily. Due to chemotherapy treatment the skin on hands and around the nail is likely to be extra dry so massage your hands and feet daily (you simply can’t do this enough) paying particular attention to the cuticles and all around the nails.
8. Use rich, concentrated moisturisers that are ideally natural and unscented. Avoid any exfoliating lotions and hand creams that contain glycolic acid, lactic acid, salicylic acid, alpha-hydroxy acids (AHA) or Beta Hydroxy Acid (BHA). These acids work by removing the top layers of dead skin cells and can therefore weaken nails.
9. Some people find that soaking their hands in natural oils, such as olive, almond or coconut oil, is helpful. Many people do this before going to bed and try using cotton gloves or socks over hands and feet to soften them further overnight.
Can I have a professional manicure while going through chemotherapy treatment?
Some people avoid professional manicures or pedicures, but the main reason for this is to avoid the risk of infection as the immune system is weakened during chemotherapy treatment, and nail salons can often harbour bacteria. If you want a professional manicure, ensure that the nail technician’s hygiene standards are up to scratch or alternatively, take your own sanitised instruments.
It is advisable to avoid using artificial nails. Artificial nail adhesives have chemicals that may cause an allergic reaction, such as swelling or inflammation. Fake nails can also trap bacteria that may cause infections.
Can I use nail polish while going through chemotherapy treatment?
There is a lot of conflicting advice around whether you can use nail varnish during chemotherapy treatment. Polish will dry nails, so if nails are already very dry or falling off, it might be better to use a nail moisturiser or strengthener.
Research conducted by the State University of New York shows that chemotherapy treatments (in particular taxane based treatments) increase the sensitivity of the nail to UV light and that nail damage increases with exposure to sunlight. In order to protect nails from the sun, many people paint their nails with either anti-UV nail varnish or with a dark coloured polish, however some chemo nurses will ask for dark polish to be removed so they can see any signs of inflammation, pain or infection.
The best advice here is to speak to your specific care team about their policies regarding nail polish.
If you want to paint your nails, make sure to use a nail polish you’ve used before to decrease the risk of having an allergic reaction. You could also consider using a water-based polish. Conventional nail polishes tend to contain chemicals such as formaldehyde to harden and stabilise them that are considered toxic, plus a water-based polish will be easier to remove. If you are using a dark polish, we would recommend applying a clear base coat first to avoid any additional staining of the nails from the polish. Quick drying nail varnish is best avoided as it can make nails even drier.
To remove nail varnish, opt for an acetone-free nail polish remover as it is less drying than an acetone based one and try to remove polish as infrequently as possible. Benecos Nail Polish Remover is often recommended as it only contains natural ingredients, although you do have to scrub a bit harder than with conventional remover!
Finally, if a nail becomes loose, do not pull it off. It's better to lightly cover the area with a plaster or gauze (to avoid accidentally ripping off your nail) and allow it to fall off on its own.
And please ensure to tell your medical care team if you notice any signs of inflammation or infection.
It is recommended to continue with a nail care routine for at least 3 months post treatment, but the good news is that nails will usually grow out normally again after about 6 months.
A recent study suggests that cold therapy, including frozen gloves and frozen socks, can help prevent some of the skin and nail side effects specifically caused by taxane chemotherapy. The analysis found that four out of six studies (67%) on nail side effects showed that frozen gloves helped prevent nail side effects. In other words people who used nail cooling had fewer changes in their nails than people who didn’t. Nail cooling seems to be most effective in helping to keep your nail from separating from your skin, but the effects are different for everyone.
Nail cooling appears to be safe and has few risks - discomfort was common among people using frozen gloves and socks, and one person developed frostbite.
If you are interested in trying nail cooling, you should speak to your medical care team to find out if it is offered in your hospital.
Disclaimer: The above advice has been collated from the Cancer Community – other people going through the same things as your loved one. It doesn’t in anyway constitute medical advice. If you have any concerns, please speak with your medical care team.
If you're looking for products to help care for your nails during chemotherapy treatment, we sell a range of products to help you care for your nails, hand and feet including many of the products that Catherine mentions, in the CancerPal MarketPlace.