10.5826/dpc.1303a159
text/xml
2160-9381
3019
en
Balasundaram Mithin Kumar
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Docetaxel-Induced Nail Bed Purpura
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-11-23
2023-07-31
2023-08-24
e2023159
Dermatol Pract Concept
Balasundaram Mithin Kumar
2023/07/31
10.5826/dpc.1303a159
e2023159
Department of Dermatology and STD, JIPMER, Puducherry, India
2160-9381
en
e2023159
Roh MR, Cho JY, Lew W. Docetaxel-induced onycholysis: the role of subungual hemorrhage and suppuration. Yonsei Med J 2007;48:124–6.
Docetaxel-Induced Nail Bed Purpura
https://dpcj.org/index.php/dpc/article/download/3019/2234
                     Docetaxel-Induced Nail Bed Purpura
     Arunachalam Narayanan1, Devinder Mohan Thappa1, Balasundaram Mithin Kumar1


1 Department of Dermatology and STD, JIPMER, Puducherry, India



Citation: Narayanan A, Thappa DM, Mithin Kumar B. Docetaxel-Induced Nail Bed Purpura. Dermatol Pract Concept.
2023;13(3):e2023159. DOI: https://doi.org/10.5826/dpc.1303a159
Accepted: December 15, 2022; Published: July 2023
Copyright: ©2023 Narayanan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Dr. Arunachalam Narayanan, MD, Senior Resident, Department of Dermatology and STD, JIPMER,
Puducherry-605006. E-mail ID: narayanan359@gmail.com




Case Presentation                                                        disassembly. Nail changes seen post-treatment with docetaxel-
                                                                         based chemotherapy include onychomadesis, onycholysis,
A 57-year-old male patient presented to our outpatient                   beau’s lines, paronychia, and nail bed purpura [1]. The direct
clinic with reddish discoloration of the nail plates. He was a           toxic insult to the nail bed epithelium results in the formation
known case of moderately differentiated adenocarcinoma of                of hemorrhagic bulla and onycholysis [2]. Secondary infection
the stomach and was on treatment with docetaxel-based che-               of the collected blood can also be present, which may present
motherapy (docetaxel 75 mg/m2 and oxaliplatin 130 mg/m2                  as intense pain due to pressure effect. Under dermatoscopy,
on day 1 followed by capecitabine 1000 mg/m2 orally twice                hemorrhages would appear as presence of globules of varying
daily on days 2-14) for the last 2 months. Examination of his            colors including purple, violet, and red. Management includes
nails revealed subungual onycholysis of his bilateral great              antibiotics for the treatment of paronychia. Nail bed purpura
toes along with nail bed purpura over the third right toe                resolves spontaneously after treatment is stopped.
and multiple fingernails (Figure 1A). Dermatoscopy revealed
presence of circumscribed red homogenous blotches on mul-
tiple fingernails (Figure 1B). Based on the above features, we           References
made a diagnosis of docetaxel-induced nail bed purpura and                1. Capriotti K, Capriotti JA, Lessin S, et al. The risk of nail changes
subungual onycholysis.                                                       with taxane chemotherapy: a systematic review of the literature
                                                                             and meta-analysis. Br J Dermatol. 2015;173(3):842-845. DOI:
                                                                             10.1111/bjd.13743. PMID: 25704465.
Teaching Point                                                            2. Roh MR, Cho JY, Lew W. Docetaxel-induced onycholysis: the
                                                                             role of subungual hemorrhage and suppuration. Yonsei Med J.
Docetaxel is a semisynthetic analogue of paclitaxel that acts by             2007;48(1):124-126. DOI: 10.3349/ymj.2007.48.1.124. PMID:
binding to beta tubulin subunit of microtubule resulting in its              17326255. PMCID: PMC2628000.




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023159                                                                                     1
Figure 1. (A) Nail bed purpura over fingernails. (B) Dermatoscopy revealing presence of circumscribed red homogenous blotches on
fingernails.




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