A 60-year-old African American man receiving docetaxel for adenocarcinoma of the prostate developed blue lunula on his right and left thumb 3 months after starting docetaxel. Three months after discontinuing the docetaxel, his nail beds returned to their original color.5
Hydroxyurea has been used in the treatment of chronic myelogenous
leukemia; however, a 45-year-old man with recalcitrant
plaque psoriasis who took hydroxyurea 500 mg twice daily developed
blue lunula 2 weeks after starting the drug.6 Physical
examination showed uniform blue pigmentation in all fingernails
in addition to psoriasis-associated nail changes of nail
pitting and thickening. Three potential mechanisms to account
for hydroxyurea-associated nail dyschromia have been postulated:
(1) toxic effects to the distal nail matrix basal cells, (2)
pigment deposition in the nail matrix, or (3) focal stimulation of
melanocytes to produce melanin.6
Single-agent and combination-drug antineoplastic therapy
can be associated with hair, mucocutaneous, and nail adverse
sequelae. Our patient received cisplatin, ifosfamide, temozolomide,
and vincristine; she subsequently developed not only
macular black pigmentation on her tongue, but also blue lunula
on the nails of her fingers and thumbs. The blue lunula resolved,
and the tongue pigmentation was beginning to fade 18 months
after the casual agents were discontinued. Albeit uncommon,
coincident dyschromia of the tongue and lunula of the nails may
occur following multiagent cancer chemotherapy.
The authors have no relevant conflicts of interest to disclose.
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- Rao SP, Potnis AV, Sobrinho TC, Brown AK. Pigmentation of the tongue after treatment with adriamycin. Cancer Treat Rep. 1976;60(9):1402-1404.
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