Jan 28, 2016

Preventing nail damage during chemotherapy – the UK polybalm RCT launched

Several cancer treatments can cause nail damage (onycholysis) but chemotherapy is the worst culprit, particularly taxotere and taxol. Milder nail damage can be caused by other chemotherapy agents such as anthracyclines and capecitabine, biological agents such as cetuximab or even herceptin. Some women report nail changes following hormone drugs such as tamoxifen and the aromatase inhibitors (e.g. anastrozole and letrozole). Numerous patient advocacy groups advise preventing nail damage by massaging the nail bed with a balm to maintain moisture and prevent skin splitting.

The degree of nail damage

This depends on the type of chemotherapy, the dose received, how many cycles are given, the individual’s sensitivity to nail damage and how the nails are cared for during chemotherapy.

Types of nail damage

Initially, white lines across the nails, which look like the rings of a tree (beau’s lines), can appear; these correspond to the cycles of chemotherapy. Later the nails can get weak and brittle, crack, break easily and change colour. In more severe cases, they start lifting from the nail beds and ooze clear fluid from underneath them, which can be very uncomfortable and often painful. They can become secondarily infected and the clear fluid turns to pus, which is a very distressing symptom.

A recent study

The double-blind, placebo-controlled, randomised evaluation of a polyphenol-rich nail balm – The Polybalm study

There are no published prospective trials to support the use of nail balms during chemotherapy, or in an otherwise healthy population. Likewise, there is no guidance on the type of balm to use. Natural plant-based waxes and essential oils have anti-inflammatory and anti-microbial properties, and it is hypothesised that these have added benefits other than simply oiling the nail bed with more commonly used hydrocarbon-based balms.

Study aims and rationale This study compares the incidence of nail damage following regular use of a nail bed balm made from natural wax bases and essential oils, with petroleum-based nail salves.

Methods A double-blind, randomised trial involving 50 patients receiving chemotherapy, with at least 25 receiving taxotere, the chemotherapy agent most likely to cause onycholysis. A nail health questionnaire will be completed at screening and at the last cycle of chemotherapy. The toxicity score and grading of the visual damage, will be independently measured and statistically evaluated at Cranfield University.

Potential clinical benefit of this trial If this hypothesis is proven to be correct, this technique could prevent the discomfort and risk of nail damage experienced by many thousands of patients receiving chemotherapy every year across the world.

Other tips and advice

Other tips to protect your nails during chemotherapy

  1. Special gloves to cool the nail beds have been investigated, and certainly help and are commercially available but are not popular with chemotherapy nurses to cool the nail beds. This technique has been evaluated in clinical trials and is used throughout Europe but largely ignored in the UK; it involves cooling the nail beds during the chemotherapy infusion and for 20 minutes afterwards. Cool water can be used and specifically designed gloves are available in France. For more details you can also link to the case report published in the Medical Journal Focus on Cancer Medicine >> Screen Shot 2015-12-22 at 19.05.42.
  2. Moisturise the nail beds. We have teamed up with a natural cream maker (see link below) to develop a nail balm that contains only natural waxes and rare essential oils selected for their anti-inflammatory and DNA-stabilising properties. This cream can be used on the lips or the nail beds. We recommend massaging onto the nail bed three times a day for the duration of the chemotherapy.
  3. Protect the nails. Anecdotal reports suggest that nail varnish can protect the nails – it certainly covers up the discolouration, and may prevent splitting and flaking.
  4. Keep the nails clean short and protected from trauma – wear gloves when gardening or washing the dishes for example

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