Nail Changes - Paronychia

Cutaneous appendages depend on EGFR signalling for normal development and function. Consequently, alterations in the hair and nails develop in EGFRI-treated patients, albeit less frequently than the papulopustular rash.1

Definition: Paronychia is an often tender inflammation of the nail fold (mainly of the big toe, although other toes and fingers may also be involved). This Paronychia can be very painful and mimics an ingrown toenail in the severe cases where Pyogenic granuloma of the nail fold develops. Secondary infection with Staphylococcus aureus is not uncommon.2 Due to local pain, limitations of ADL may occur rapidly.

Incidence: Common.3,4,5,6,7

Onset: Not earlier than 4 weeks after treatment initiation.8

Resolution: Only after weeks of completion of EGFRI treatment.

ICD10 code:

  • L03.0 Cellulitis of finger and toe.

Grade 1

Localised, local intervention indicated.

Typical clinical presentations of garde 1 Paronychia can be viewed at the bottom of the page.

Grade 2

Oral intervention indicated (eg antibiotic, antifungal, antiviral).

Typical clinical presentations of grade 2 Paronychia can be viewed at the bottom of the page.

Grade 3

i.v. antibiotic, antifungal, or antiviral intervention indicated; radiologic or operative intervention indicated; Pyogenic granuloma.

Typical clinical presentations of garde 3 Paronychia can be viewed at the bottom of the page.

References

1Lacouture ME. Nat Rev Cancer 2006; 6: 803-812.
2Segaert S & Van Cutsem E. Ann Oncol 2005; 16: 1425-1433.
3European Medicine Agency. Tarceva® (erlotinib) Summary of Product Characteristics 2009.
4European Medicine Agency. Iressa® (gefitinib) Summary of Product Characteristics 2009.
5European Medicine Agency. Erbitux® (cetuximab) Summary of Product Characteristics 2009.
6European Medicine Agency. Vectibix® (panitumumab) Summary of Product Characteristics 2009.
7European Medicine Agency. Tyverb® (lapatinib) Summary of Product Characteristics 2010.
8Roé E et al. J Am Acad Dermatol 2006; 55: 429-437.

Last update: 10 May 2009

Grade 1 Paronychia

Grade 2 Paronychia

Grade 3 Paronychia