This is an answer to the Case – Multiple White Lines on the Fingernails
A 69-year-old man was referred for the evaluation of changes to his fingernails that developed after the initiation of chemotherapy with docetaxel–cisplatin–fluorouracil for gastric cancer.
Physical examination revealed multiple white lines on the fingernails, known as Beau’s lines. The lines corresponded to the start of each chemotherapy cycle, with the distance between the lines proportional to the interval between the cycles.
One white line showed less severe dystrophia than the others (arrow); on reviewing the medical records, it was noted that the corresponding chemotherapy cycle consisted of docetaxel–fluorouracil only, owing to the patient’s compromised renal function at the time, whereas all the other cycles consisted of the complete docetaxel–cisplatin–fluorouracil regimen.
Cytotoxic chemotherapeutic agents can induce the temporary arrest of proliferative function of the nail matrix, which may be manifested as multiple Beau’s lines in the nail plate. This nail pattern can provide insight into the interval between and intensity of chemotherapy cycles.
Citing Articles:
- Mark Holzberg. 2021. Recent Advances in Nails in Systemic Disease. Advances in Nail Disease and Management, 87-99. https://link.springer.com/chapter/10.1007%2F978-3-030-59997-3_9
- Ahmed Saif Eldeen, Mohamed AitGacem, Saifeddin Alghlayini, Wessam Shehieb, Mustahsan Mir. (2020) Vitamin Deficiency Detection Using Image Processing and Neural Network. 2020 Advances in Science and Engineering Technology International Conferences (ASET), 1-5. https://ieeexplore.ieee.org/document/9118303
- Adam Rubin, Mark Holzberg, Robert Baran. 2018. Physical Signs. Baran & Dawber’s Diseases of the Nails and their Management, 59-104. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119323396.ch2
- Neng-Sheng Chu, I-Chen Wu, Li-Tzong Chen, Yi-Ying Chin. (2018) Beau’s lines in nails: An indicator of recent Docetaxel and 5-FU use. The Kaohsiung Journal of Medical Sciences 34:3, 181-183. https://onlinelibrary.wiley.com/doi/full/10.1016/j.kjms.2017.09.008
- Sally Tan, Maryanne Makredes Senna. (2017) Hair and Nail Manifestations of Systemic Disease. Current Dermatology Reports 26. https://link.springer.com/article/10.1007%2Fs13671-017-0169-6
- María José Aldunce-Soto, Rosamary Soto Paredes, Manuel Sánchez-Regaña, Montserrat Salleras Redonnet. (2016) Alteraciones ungueales inducidas por fármacos. Piel 31, 189-197. https://www.sciencedirect.com/science/article/pii/S0213925115002956?via%3Dihub
- Hallam M. Gugelmann, David F. Gaieski. (2013) Beau’s Lines After Cardiac Arrest. Therapeutic Hypothermia and Temperature Management 3:4, 199-202. https://www.liebertpub.com/doi/10.1089/ther.2013.0016
- Bianca Maria Piraccini, Aurora Alessandrini. (2013) Drug-related nail disease. Clinics in Dermatology 31, 618-626. https://www.sciencedirect.com/science/article/abs/pii/S0738081X13001429?via%3Dihub
- Martin N. Zaiac, Ashley Walker. (2013) Nail abnormalities associated with systemic pathologies. Clinics in Dermatology 31, 627-649. https://www.sciencedirect.com/science/article/abs/pii/S0738081X13001478?via%3Dihub
- C.- C. Chang, C.- C. Wu. (2013) Beau’s lines. QJM 106, 383-383. https://academic.oup.com/qjmed/article/106/4/383/1517228
- Adam I. Rubin, Robert Baran. 2012. Physical Signs. Baran & Dawber’s Diseases of the Nails and their Management, 51-99. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118286715.ch2
- Laju M. Patel, Phelps J. Lambert, Claude E. Gagna, Amin Maghari, W. Clark Lambert. (2011) Cutaneous signs of systemic disease. Clinics in Dermatology 29, 511-522. https://www.sciencedirect.com/science/article/abs/pii/S0738081X11000459?via%3Dihub
- Bénédicte Lebrun-Vignes, Céline Bris, Bénédicte Lelièvre, Bertrand Diquet. (2011) Ongles et médicaments. Revue Francophone des Laboratoires 2011:432, 77-81. https://www.sciencedirect.com/science/article/abs/pii/S1773035X11709558?via%3Dihub
