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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : WC01 - WC04 Full Version

Recognising Nail Changes Induced by Chemotherapy with Taxane-based Regimens and their Dermoscopic Confirmation: A Prospective Observational Study from Northern India


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55977.16870
Rupinder Walia, Shivali Aggarwal, Dimple Chopra, Shayna Aulakh, Anushruti Aggarwal, Sharang Gupta, Preeyati

1. Assistant Professor, Department of Dermatology, Venereology and Leprology, GMC Patiala, Punjab, India. 2. Assistant Professor, Department of Dermatology, Venereology and Leprology, GMC Patiala, Punjab, India. 3. Professor and Head, Department of Dermatology, Venereology and Leprology, GMC Patiala, Punjab, India. 4. Junior Resident, Department of Dermatology, Venereology and Leprology, GMC Patiala, Punjab, India. 5. Senior Resident, Department of Dermatology, Venereology and Leprology, GMC Patiala, Punjab, India. 6. Junior Resident, Department of Dermatology, Venereology and Leprology, GMC Patiala, Punjab, India. 7. Medical Intern, Department of Dermatology, Venereology and Leprology, GMC Patiala, Punjab, India.

Correspondence Address :
Shivali Aggarwal,
Department of Dermatology, Venereology and Leprology, Government Medical College, Patiala, Patiala, Punjab, India.
E-mail: shivali390@gmail.com

Abstract

Introduction: Taxanes are chemotherapeutic agents used in a variety of solid tumours. They are known to cause cutaneous as well as nail changes which are temporally associated with intake of drug. Nail involvement is reported in literature from some parts of the world.

Aim: To study the pattern of nail changes occurring due to taxane-based chemotherapy regimens in patients suffering from malignancies.

Materials and Methods: A prospective observational study was carried out in a tertiary care hospital in GMC, Patiala, Punjab, India from October 2020 to September 2021. A total of 160 adult patients undergoing cancer chemotherapy with taxanes were included in the study. After taking detailed history, nail changes were examined and confirmed by dermoscopy. The data was analysed using Epi Info 7 by CDC and Chi-square test was used to calculate the p-value.

Results: A total of 144 patients (87 females and 57 males), with the mean age of 53.8 years, were screened for six chemotherapeutic cycles. Drug-induced Nail Pigmentation (DINP) was the most common nail abnormality seen in 43/144 (30%) patients after third cycle and in 105/144 (73%) patients after the sixth cycle. The most common pattern was diffuse nail pigmentation 40/105 (39%) followed by longitudinal melanonychia 22/105 (21%) after six cycles. Maximum pigmentation 52/60 (86%) was observed in patients who received taxane+adriamycin+ cyclophosphamide combination. On onychoscopy, DINP appeared as thin grey regularly arranged parallel longitudinal lines on homogenous grey background.

Conclusion: Taxanes cause varied pattern of nail changes with DINP being the most common. It ranges from longitudinal bands after three cycles to diffuse pigmentation after six cycles.These nail changes show temporal relation with dose, duration, number of drugs, and colour of skin. Dermoscopy is a novel non invasive method with a good diagnostic accuracy.

Keywords

Taxanes, Longitudinal melanonychia, Nail pigmentation

The taxanes (paclitaxel and docetaxel) have proven to be effective in the treatment of a variety of solid tumours including breast, ovarian, lung and bladder cancers (1). These exert cytotoxic effect by disrupting the balance between polymerisation and depolymerisation of microtubule leading to arrest at G2/M phase of the cell cycle (2). Paclitaxel and Docetaxel are usually administered intravenously every three weeks either alone or in combination. The standard dose of Paclitaxel according to this schedule is 175 mg/m2 (3 hours infusion) while Docetaxel is administered as a one hour intravenous infusion at 75-100 mg/m2 (3). The most common side-effects observed are myelosuppression, neuropathy, fatigue, alopecia, stomatitis, hypersensitivity reaction and a fluid retention syndrome (4),(5).

Cutaneous toxicity has been reported with taxanes and includes erythema and desquamation, involving primarily the hands (3). The nail matrix cells which are continuously dividing, also become a target of antimitotic activity of chemotherapeutic agents. The nail changes may involve some or all nails and have a temporal onset with drug intake. In most cases the nail changes are only cosmetically disturbing, however at times associated pain and discomfort may require alteration in chemotherapy (6). Nail changes are mostly transitory, with the nail eventually growing out normally after discontinuation of treatment but at times these changes may persist (7). Common nail changes reported include a wide spectrum depending upon the nail constituent involved. Drug Induced Nail Pigmentation (DINP) is the most common followed by splinter haemorrhages, subungual haematoma, Beau’s lines, acute paronychia and onycholysis (3).

The overall incidence of nail changes with taxanes has not been systematically investigated and tends to vary widely across the literature.The overall incidence varies from 44% (3) to some series reporting it as 89% with three treatment cycles of Docetaxel (7). Yet another study has reported that nail changes increased above 10% after 2.8 weeks upto 40% at six months (8). A meta-analysis conducted for all grade of nail changes reported it as 34.9 % (95% CI 29.9-40.2)with Docetaxel and 43.7% (95% CI 18.0-73.3 for Paclitaxel) (9).

The clinical spectrum varies widely from DINP to painful onycholysis and subungual haematoma (10). As DINP is the most frequent side effect (3) it was relevant to see if it showed racial variation. There is paucity of studies undertaken for taxanes in Indian population, so this study was conducted to identify the clinical spectrum of nail changes, induced by taxane-based regimens, along with their dermoscopic evaluation in North Indian population over a period of one year.

Material and Methods

A prospective, observational study was carried out at GMC, Patiala, Punjab from October 2020 to September 2021.The study was conducted after taking clearance from the Institutional Ethical Review Committee ((Trg).EC/NEW/INST/2020/997/30364).

Inclusion criteria: All adult patients undergoing cancer chemotherapy with taxane both as monotherapy as well as combination therapy during the above mentioned period were included in the study.

Exclusion criteria: Patients with history of nail problems, those having cutaneous or systemic diseases causing nail changes, or in occupations involving contact with chemicals were excluded.

Study Procedure

A total of 160 patients undergoing cancer chemotherapy with taxane both as monotherapy as well as combination therapy were included. After taking informed consent, the demographic data along with the type of primary malignancy, chemotherapeutics used prior to taxane (if given), type and dose of taxane, adjuvant therapy and chemotherapeutic cycle with respect to occurrence of nail changes were recorded. Nail examination was done in broad daylight and the nail changes were photographed and recorded thrice during the course of therapy at at baseline and subsequently after 3 and 6 cycles. Dermoscopy was performed using Heine delta 20T (Heine optotechnik, Herrsching, Germany) handheld dermatoscope. Sixteen patients were lost to follow-up during the study period.

Statistical Analysis

The data was collected and analysed using Epi Info 7 by CDC. Chi square test was performed on the data, and a p-value<0.05 was considered to be significant.

Results

Out of total 144 patients, 57 were males and 87 were females. The mean age of the study population was 53.8 years (31-77 years). The most common malignancy was carcinoma breast 67 (46.5%), and the chemotherapy protocol followed in maximum patients 60/144 (41.6%) was Taxane+Adriamycin+Cyclophosphamide (Table/Fig 1). Post chemotherapy nail changes were seen in 126/144 (87.5%) patients, 87 amongst them reported changes after 3rd cycle. Most common first affected site was finger nails with atleast one or two nails affected. Toe nails were the first affected site in six patients only. With an increase in the number of cycles, nail involvement extended to other digits of the hands and feet (Table/Fig 2).

Drug-induced Nail Pigmentation (DINP) was the most common change observed. It was seen in 30% patients after the third cycle, and 73% patients after the sixth cycle. Other nail changes recorded were longitudinal ridging, Beau’s lines, Mees’ lines, and nail plate thinning (Table/Fig 3).

After 3rd cycle, one or more longitudinal lines (longitudinal melanonychia striata (Table/Fig 4) were seen in 14/43 (32.5%) followed by diffuse pigmentation in proximal nail in 10/43 (Table/Fig 5)a,b whereas after the 6th cycle diffuse pigmentation in whole nail was the commonest DINP 40/105 (38%) (Table/Fig 6).

On analysis of the chemotherapy protocol of patients, maximum pigmentation (86%) was observed in patients who received taxane+adriamycin+cyclophosphamide.In the other three regimes the incidence of pigmentation was in the range of 61-66%. Melanonychia caused by taxanes and combination drug regimens have been found to be statistically significant (p=0.018) (Table/Fig 7).

On dermoscopy, DINP appeared as homogenous grey coloration of background with longitudinal, regularly placed parallel grey lines (Table/Fig 8)a,b,c.

Discussion

Taxane-based regimes, one of the most commonly used chemotherapeutic agents in the treatment of solid neoplasms, are burdened by the development of side-effects in different organs. Involvement of the skin, hair and nail cause cosmetic disfigurement affecting quality of life of the patient. Proper knowledge of these changes will help in counselling of patients for better compliance.

In this study, by adopting a proactive approach, even the slightest nail abnormalities which was otherwise of little concern to the patient was picked. Hence a significant percentage of nail abnormalities (87.5%) were noticed giving a more realistic picture of the incidence of nail changes. This is in contrast to those studies which included only referrals from Oncology department who had more severe nail changes mostly with associated pain (3),(11).

The average age of patients was 53.8 years (range 31-77), suggesting that nail toxicity affects mainly the adult population; however, this evidence is probably distorted by the fact that the malignancies we reported mostly affect the adult population, saving the younger age. The male: female ratio was 1:1.6. Females were more as breast cancer was the most common malignancy in our study.

Alessandrini A et al. reported that most of the patients presented simultaneous involvement of hands and feet (46.8%) (11). But in this study, 51/87 patients had only fingers involved after 3rd cycle while 96/144 showed involvement of both fingers and toes after six cycles (Table/Fig 2). The earlier involvement of finger nails can be attributed to faster rate of growth of finger nails.

DINP, being the most frequent change, was seen in 43/144 (30%)patients during midtreatment and 105/144 (73%) at six months. Thus, the development of nail alterations is strongly associated with the number of chemotherapy cycles, and it increases with the taxane cumulative dose (12). However the frequency of therapy cannot be commented on as only one patient was on weekly regime. Pavey RA et al., also found melanonychia to be the most common (13) and Trivedi M et al., reported it in 54.26% of patients with use of chemotherapeutic combinations (14). In the study conducted by Puri KJPS et al., melanonychia was seen in 58% (91/158) with various taxane based combination (15).

Clinical presentation of DINP depends on anatomic component of the nail unit that has been affected. Postulated mechanisms include accumulation of drug in nail plate or at dermal level causing toxic effect on melanocytes in nail matrix leading to activation of matrix melanocytes inducing increased melanin production (6). The occurrence of DINP in one patient of vitiligo in our study support the toxic effect of the drug accumulated at nail plate or dermal level (Table/Fig 9). The nail matrix contains melanocytes in the lowest two cell layers, unlike in normal skin, where they are confined to the basal layer (15). Matrix melanocytes also differ from melanocytes elsewhere by their inability to produce melanin in normal circumstances, especially in white people, which explains the increased incidence of melanonychia observed in darker races.

Varied incidence of melanonychia due to taxanes has been reported in different races-2.5% in Caucasians (may not represent the real picture as includes those patients only who reported nail signs associated with pain or discomfort), 35.7% in Turkish population, 58% in Indians, while in this study it was 73% (11),(14),(16). Activation of a cluster of melanocytes give rise to longitudinal melanonychia while diffuse activation of melanocytes would result in diffuse nail pigmentation. In the present study, longitudinal melanonychia predominated during initial cycles, while diffuse pigmentation (38%) was most common after six cycles. Diffuse pigmentation of nails was also the most common nail plate change (16.1%) in study by Praveen KS et al. following chemotherapy with taxanes (17). Nail fold pigmentation was seen in 24/144 (16.6%) patients, whereas, it was reported as 20% with taxanes in the study by Praveen KS et al. similar to the index study (17). Periungual xerosis was observed in 12/144 (8.3%) and ragged cuticle in 6/144 (4.16%). Longitudinal ridging was observed in 42/144 (21.1%) and Mees’lines, which appear as transverse white bands parallel to lunula due to retention of matrix keratinocyte nuclei in nail plate (parakeratosis), were seenin 11.11% (Table/Fig 10). Both the above observations were in accordance to previous studies (15),(17). Subungual haematoma was seen in 9/144 (6.25%) cases. Taxane-induced thrombocytopenia and impaired nail blood flow are implicated in subungual haematoma (Table/Fig 11)a,b. Zawar V et al., reported splinter/subungual haemorrhages in 11.9% patients on taxane-and doxorubicin-containing chemotherapy (18). Beau’s lines were observed in 6% patients in the present study. It is produced due to acute toxicity to nail matrix with transient arrest in nail plate production (19). Saraswat N et al., observed Beau’s lines in 25% of their patients on all chemotherapeutics (6). Zawar V et al., observed Beaus lines in 11.9%with taxanes, indicating that Beau’s lines are mainly due to other chemotheraputic agents (18). In this study, onychoscope was used to evaluate DINP. Characteristic dermoscopic finding consisted of a homogeneous gray colouration of the background with longitudinal, regularly placed, parallel graylines. Yorulmaz A et al., have also reported similar onychoscopic findings in DINP (16). Homogenous grey colouration indicates melanocyte activation while regularly placed parallel grey lines support benign character (20). Pigmentation occurring due to benign melanocyte proliferation shows brownish hue (21) while exogenous pigmentation does not have longitudinal pattern.

Thus patient’s history, correlating the beginning of symptoms with the timing of drug exposure, clinical pattern and dermoscopy can help the clinician in reaching the diagnosis of drug induced nail changes.

Limitation(s)

In this study, taxane as monotherapy was given only in nine patients, while majority were administered taxane-based combination regimens. Also, the correlation between the morphological patterns of nail changes and the underlying malignancy or its staging could not be established.

Conclusion

Chemotherapeutic drugs can cause different types of nail changes invarying frequency causing significant morbidity, cosmetic disfigurement, and psychological distress. They may cause undue fear regarding the progression of underlying malignancy. Dermoscopic confirmation of these changes will help to increase diagnostic accuracy regarding the cause of nail changes. This will allow achievement of ideal duration of chemotherapy administration, as well as optimization of response rates.

References

1.
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DOI and Others

DOI: 10.7860/JCDR/2022/55977.16870

Date of Submission: Feb 28, 2022
Date of Peer Review: Apr 26, 2022
Date of Acceptance: Jun 13, 2022
Date of Publishing: Sep 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 07, 2022
• Manual Googling: May 23, 2022
• iThenticate Software: Aug 23, 2022 (18%)

ETYMOLOGY: Author Origin

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