Toenail Care and Nail Disorders Due to Chemotherapy

Prevent Nail Problems and Infections During and After Treatment

Discoloration of nails after chemotherapy. Side effects from breast cancer treatment.

During my chemotherapy, I had an anthracycline (Adriamycin), a taxane (Taxol) and 5-FU (5-fluorouracil). All three types of drugs can cause onycholysis – damage to the tissue that keeps your fingernail and toenails in place. The nurses assured me that my nail problems would resolve about six months after completing chemo, but it would take longer for toenails.

My favorite oncology nurse, herself a breast cancer survivor, suggested that I wear shoes that had plenty of toe room while I was in treatment. Wide-toed shoes allow for better circulation, which may speed healing. "Once you switch to wide-toed shoes, you'll never go back!" she said, noting the improved comfort.

Toenail Care Tips

Toenails grow half as fast as fingernails, or about half a centimeter every three months. Like fingernails, toenails can develop disorders, lines, ridges, discolorations, and even come loose during chemotherapy. To keep your toenails healthy during treatment and recovery, try these tips:

  • During a chemo infusion, try soaking your fingers and toenails in ice water. Like sucking on ice while having chemo, this can help prevent nail problems as well as mouth sores.
  • Clip toenails straight across, keeping them short. This helps prevent breakage and splitting, as well as ingrown toenail. Try soaking your toes in warm water for a short while before clipping the nails, as this will soften them, and may prevent splitting or cracking as you cut your nails.
  • Keep your toenails clean and moisturized. If you do a pedicure, sterilize your tools in bleach and water beforehand, to prevent infections. Cut away any loose cuticle, don't rip, as this may cause bleeding and leave you prone to infection.
  • Fragile nails may be strengthened with biotin, a water-soluble B-complex vitamin, at 5 mg per day. Tea tree oil can be used for fungal infections in toenails, if those occur. Clear polish may also help protect toenails during treatment.
  • Try to avoid injury to your toes, as bruises will heal very slowly.
  • Wear open-toed or comfortable wide-toed shoes, to improve circulation and provide protection for loose or fragile toenails.

If your nails become infected, inflamed, or quite painful, check with your doctor about how to treat them. Over-the-counter remedies may be fine for fungal infections, or you may need to have your doctor prescribe a medication to help combat the problem.

At ASCO 2017 a group of researchers from ​UK reported the results of a double-blind randomised study which investigated a natural plant based balm (PolyBalm®) in the setting of chemotherapy induce nails side effects. The product significantly improved the nail toxicity that occurred during chemotherapy.

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