Nail Care Guidelines for Cancer Treatments

Tips for Embarking on Cancer Treatments

Chemotherapy and other cancer treatments can damage the finger and toe nails causing discomfort and disfigurement. This can last many months even after treatment has finished. The severity ranges from mild ridges (Beau's lines) to troublesome damage (Onycholysis) which can affect everyday activities. Secondary infection (Paronychia) can set in particularly with some of the newer biological agents such as Tyrosine Kinase Inhibitors (TKI's). 

The first symptoms are usually burning and pain, starting in the base of the nail, then the physical changes appear. Damage increases as treatment cycles progress, especially with Taxane containing regimens. In terms of management, it is important to try and prevent the damage in the first place, as once damage has set in, it is harder to manage (1). Let your oncologist or chemotherapy nurse know if you get any early symptoms or signs of nail damage. 

These guidelines were written by a mulidisciplinary panel of oncology nurses, patients and dermatologists, led by oncologists from Bedford and Addenbrookes's Cambridge University Trusts. This advice is based on their own research experiences as well as data from published evidence across the world. They aim to provide practical tips for patients about to embark on cancer treatments:

Manicure and cleaning: Keep your nails neatly trimmed. Clip any excess nails that might catch on things and tear the nails, but do not over-trim or pick at the nail beds. Ensure you clear debris from under the nails and around the nail beds, which may contain fungus and bacteria. A metal nail pick may cause further damage; try a wooden one. If you have a pedicure, do not let your beautician use any razor-like tools to remove dead skin or let them cut your cuticles. Ensure all the equipment is sterilised correctly.

Protect your nails: During gardening, use cotton gloves to protect your fingernails. Rubber gloves should be worn when washing dishes to prevent exposure to harmful chemicals and further drying of already sensitive skin. Take particular care if doing manual work or repairs involving hammering.

Nail biting: If you bite your nails, break the habit by wearing cotton gloves. Biting your nails increases the chances of infection.

Avoid artificial nails: They can be nest for infections. The chemicals used to remove false nails can cause drying and further damage to already weakened nails. Do not have your nails drilled (filed with an electric tool), as this will cause more nail damage.

Hand sanitisers: These have a high alcohol content. Alcohol is an irritant that will also dry nails made susceptible to damage by chemotherapy. Always opt to wash your hands with soap and water and only use sanitiser if this is not available.

Soap and hand washing: When washing hands and feet, ensure they are wet before applying soap. Wetting hands and feet will reduce soap’s irritating effect on nails. Choose a natural, preferably scent free soap and ensure it does not contain Sodium Laureth Sulfate (SLS) or parabens (preservatives) which could be irritating. Rinse hands and feet with plain water until all the soap is removed and dry hands and feet thoroughly afterwards.

Nail varnish / Polish: Patients are often advised to wear dark nail varnish. This is actually a myth; no published clinical trials have shown any benefit. Many nail varnishes are made of strong chemicals, especially quick drying ones which aggravate nails and skin made sensitive by chemotherapy (2). If you use nail varnish, choose a water-based one. When removing nail varnish, ensure the remover is acetone-free.

Oiling and applying balms: Many patient groups suggest massaging oil into the skin around the nails to keep them soft and avoid cracking. Some plant-based oils can help via antioxidant and antimicrobial properties (3,4). It is however, important to avoid balms with high concentrations of essential oils which have not been tested formally, as these can irritate the nails. Applying essential oils such as tea tree directly should definitely be avoided. The major UK Polybalm study showed a significant benefit for a topical balm containing a blend of carefully selected of natural organic oils, waxes and essential oils which have anti-microbial, antioxidant and deep moisturising properties (5). This is now available commercially and is given to patients directly in some cancer units (6).

Swimming: It is important to exercise regularly during chemotherapy, so provided you are not neutropenic (check with your nurse), if you like swimming do not stop, especially if in the sea, as the salt water and minerals are good for the skin. The chlorine in a pool can reduce the moisture around your nails, so before and after swimming use the evidence based plant pure balm, mentioned above, to reduce chemical exposure to the nail beds.

Shoes: Wear comfortable, loose-fitting shoes to minimise trauma to your toenails. Once damage has set in, if one of your nails becomes loose, do not pull it off. It is better to lightly cover the area with a bandage or gauze to avoid accidentally ripping your nail off, allowing it to fall off naturally. Soak nails in salty water and then dry thoroughly.

Cooling gloves: Commercial gloves are available in some cancer units, worn during the administration of chemotherapy. These have been shown to help by constricting the blood vessels in the nail, slowing growth of the nail forming cells; onychocytes (7,8). This technique, however, has not been commonly adopted in the UK, as oncology nurses have concerns about restricting access to patients’ hands.

Diet: Severe mineral and vitamin deficiency can lead to skin, nail and hair damage but these are rare (8). As a general rule, it is sensible to ensure you eat at least 5 fruit and vegetables a day and avoid ultra processed foods. Iron deficiency can affect nails, so if your haemoglobin is below normal it would be worth asking your doctor for a blood test. Supplementation with collagen, biotin and other vitamins have not been proven to help and over-supplementation of Vitamin A and Vitamin E, has actually been linked to greater nail issues (9).

References

1. Piraccini B, Alessandrini A (2013) Drug-related nail disease. Clin Dermatol 31:618–626
2. Alshari O et al. The Effect of Nail Lacquer on Taxane-Induced Nail Changes. Breast Cancer. 2020 15;14
3. Dawid-Pać R. Medicinal plants for inflammatory skin Diseases. Postepy Dermatol Alerqol. 2013; 30(3):170-177
4. Delaquis , et al. Antimicrobial activity of essential oils. Int J Food Microbiol. 2002; 74(1-2):101-109.
5. Thomas R et al. A double-blind, randomised trial of a polyphenolic-rich nail bed balm for chemotherapy induced onycholysis: The UK Polybalm study. Breast Cancer Research and Treatment. 2018; 171 (1):103.
6. https://Polybalm.com
7. Scotté F, et al. Frozen gloves to Prevent Docetaxel-Induced Onycholysis. J Clin Oncol; 2005,23(19): 4424.
8. Ding P & Thomas R. A cool solution for docetaxel induced onycholysis. Clin Focus on Can Med 2010 2(1):18.
9. Guo E et al. Hair & nails - Nutrient deficiency and supplements. Dermatol Pract Concept. 2017, 31;7(1):1.

Article courtesy of NHS, Cambridge University Hospitals and Bedfordshire Hospitals.