Nail pigmentation induced by chemotherapy: an observational study of patients with early-stage breast cancer

Purpose Chemotherapy-induced nail pigmentation is a common adverse effect, but prospective studies focussing on its onset, recovery, and severity are few. We aim to evaluate the pattern of chemotherapy-induced nail pigmentation in early-stage breast cancer patients by calculating the comprehensive score based on hyperpigmentation area and color depth of the nail plate. Methods This prospective, observational study was conducted between February 2019 and December 2019. Early-stage breast cancer patients scheduled to receive anthracyclines combined with cyclophosphamide or taxane-containing regimens were enrolled. The clinicopathologic characteristics and treatment protocols were collected. The onset, patterns, and duration of nail changes were photographed and recorded regularly. Results A total of 90 patients were enrolled. The most common nail change was nail pigmentation ( n = 81, 90.0%), followed by onycholysis ( n = 39, 43.3%), Beau’s lines ( n = 19, 21.1%), Mees’ lines ( n = 16, 17.8%), Muehrcke’s lines ( n = 7, 7.8%), and hemorrhage ( n = 1, 1.1%). Forty-four (48.9%) patients developed severe nail pigmentation. The median onset time of nail pigmentation was 37 days after the initiation of chemotherapy. At the latest follow-up, 55(67.9%) patients achieved remission of melanonychia with the median recovery time of 118 days. The median duration of nail pigmentation was 214 days. Conclusion Our study revealed the specific pattern of chemotherapy-induced nail pigmentation, which onsets early and recovers slowly with a high incidence of severe nail pigmentation, in early-stage breast cancer patients. The results provide reference for further intervention studies. Trial Registration ClinicalTrials.gov Identifier: NCT04215744 . Registered 30 December 2019—Retrospectively registered.