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Nails help protect the ends of our fingers and toes, and allow fingers to perform activities such as scratching or picking up things. Nails are normally present on each finger and toe. They are made up of the nail plate (the hardest part of the nail and the part that can be seen) and tissue that lies underneath the nail plate.
Nails receive blood and nutrition from the body. They are attached to the body by the nail bed which is kind of like a root and receives nutrients to keep the nails healthy and to allow new nail cells to form and grow. As they grow, the newer cells push out the older cells. The older cells are pushed forward and get flatter and harder which forms the nail plate. The nail plate does not have living cells which is why nails can be cut without pain.
Nail changes are different problems that can happen to fingernails, toenails, or both. Certain types of cancer and cancer treatments can cause changes to the nails. The changes can happen in the nail bed or in the nail plate itself. Nail changes can be temporary or may last.
Depending on what is causing changes in your nails, you might notice changes in how they look, feel, and work. You might also notice changes in the tissue around or under your nails. Some common nail changes include:
Some treatments for cancer can cause damage or changes to nails. Usually the treatments that cause nail changes are medications, but radiation can also cause nail changes. Different treatments can affect normal cells, like nail cells, in different ways. And their side effects can also affect nails differently. One, two, a few, or all of your nails could be affected by changes. Some changes occur soon after you begin treatment, but others may happen weeks or months after treatment begins. Some might be temporary and others might be long-lasting or permanent.
Remember that while some cancers and cancer treatment can cause changes in your nails, non-cancer conditions and medications can also cause them. It's important to talk to your doctor about all medical problems you might have and about the medications, vitamins, minerals, and supplements you are taking so your risk can be discussed and you know what to expect.
Some medications used to treat cancer can stop the growth of nails altogether while you are taking them. If you are getting treatment in cycles, the nails may begin to grow a little in between the cycles, but may produce white horizontal lines in the nail plate, called Beau’s lines. These are harmless and will usually grow out once treatment is over.
Here are some of the changes you may have in your nails, and some of the drugs to treat cancer than can cause them. Being on more than one drug that can cause nail changes might increase how severe the side effects will be.
Type of nail change |
Some cancer treatments that can cause It |
Dark areas in cuticle |
Targeted therapy antiangiogenic multikinase inhibitors (sorafenib, sunitinib) |
Over-pigmented (hyperpigmented) nails |
Chemotherapy such as Bleomycin, capecitabine, cyclophosphamide, dacarbazine, danorubicin, doxorubicin, idarubicin, melphalan, methotrexate Targeted therapy such as EGFR inhibitors (erlotinib, gefitinib) and monoclonal antibodies ( cetuximab, panitumumab),
|
Fissures (deep grooves) |
Targeted therapy or immunotherapy monoclonal antibodies (cetuximab, panitumumab) |
Hemorrhages (splinter hemorrhage) |
Chemotherapy taxanes (doxorubicin, docetaxel, paclitaxel, nab-paclitaxel) |
Inflammation (paronychia) |
Chemotherapy taxanes (doxorubicin, docetaxel, paclitaxel, nab-paclitaxel) Targeted therapy EGFR inhibitors (erlotinib, gefitinib, dacomitinib), monoclonal antibodies (cetuximab, necitumumab, panitumumab), and mTOR inhibitors (everolimus, temsirolimus) |
Lifting of the nailbed (onycholysis) |
Chemotherapy such as dacarbazine, daunorubicin, and mitoxantrone Targeted therapy such as mTOR inhibitors (everolimus, temsirolimus) |
Nail loss |
Chemotherapy such as bleomycin and 5-fluorouracil (5-FU) |
Ridges, lines, creases, or other discoloration |
Chemotherapy such as cyclophosphamide, doxorubicin, docetaxel, hydroxyurea, idarubicin, ifosfamide, and 5-fluorouracil (5-FU) |
Many changes to nails that happen during cancer treatment can affect their appearance. For example, ridges or lines in your nails are not usually painful, but cause changes in how your nails look and feel. Once the treatment causing changes is done, the changes will usually go away over time as the nail grows out. The nail changes likely to be temporary include:
For minor, non-painful nail changes, the following might be helpful:
Some changes, however, are painful or involve an infection, and require treatment. Talk to your doctor about what is best for your situation before trying anything at home.
It may not be possible to prevent nail changes, but you can do some things to help manage minor nail changes, and to avoid making them worse. Some things you can do include:
It’s important to tell your health care team as soon as you notice any expected or unexpected changes to your nails. Prevention and avoiding injuries to your nails is an important part of keeping your nails as healthy as possible.
If you get medicine to treat your nail changes, be sure to tell your doctor how the medication is working for you or if new problems come up.
If you are concerned about nail problems or if you are at risk for nail changes, here are some questions to ask your health care team:
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.
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Matthews NH, Moustafa F, Kaskas NM, Robinson-Bostom L, & Pappas-Taffer L. Dermatologic toxicities of anticancer therapy. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper, JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2019:621-648.
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Last Revised: February 1, 2020
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