Nail changes are often very resistant to reactive treatment. Therefore, prophylactic measures, early intervention and prevention of superinfection are important.
Cut nails straight; do not remove cuticles; avoid tight shoes; wear gloves to protect skin and apply local antiseptics. The use of an ultrapotent topical steroid (eg clobetasol propionate) cream on the nail folds (possibly under occlusion) at the earliest signs of Paronychia may prevent it from worsening.1 For grade 2 Paronychia, add a topical astringent paste containing a potent steroid, antiseptic and antifungal, and use oral tetracyclines and topical silver nitrate for Pyogenic granuloma. For grade 3 Paronychia, add non-steroidal anti-inflammatory drugs, S. aureus-spectrum antibiotics in the case of superinfection and consider temporarily withholding EGFRI treatment.1
- Antiseptic soaks and creams (chloramine, chlorhexidine, povidone iodine).
- Topical clobetasol propionate.
- Topical silver nitrate (for grade 2).
- Minocycline 100 mg qd (for grade 2).
- Doxycycline 100 mg qd (for grade 2).
- Lymecycline 300 mg qd (for grade 2).
- Astringent paste containing a steroid, antiseptic and antifungal (for grade 2).
- Ibuprofen 400 mg tid, indomethacin 75 mg bid (for grade 3).
- Flucloxacillin 500 mg tid (for grade 3 when superinfection is noted).
- Cefuroxime axetil 500 mg bid (for grade 3 when superinfection is noted).
Continue with the selected EGFRI-treatment regimen if adverse events are graded 1 or 2; withhold EGFRI treatment in cases with grade 3 toxicity; continue with the selected EGFRI-treatment regimen only if toxicity mitigates to grade ≤2. Continue with/withold the selected EGFRI-treatment regimen, as recommended in the current and relevant SmPC and according to the patient’s condition. 2,3,4,5,6
1Segaert S et al. Eur J Cancer 2009; 45(Suppl 1): 295-308.
2European Medicine Agency. Tarceva® (erlotinib) Summary of Product Characteristics 2009.
3European Medicine Agency. Iressa® (gefitinib) Summary of Product Characteristics 2009.
4European Medicine Agency. Erbitux® (cetuximab) Summary of Product Characteristics 2009.
5European Medicine Agency. Vectibix® (panitumumab) Summary of Product Characteristics 2009.
6European Medicine Agency. Tyverb® (lapatinib) Summary of Product Characteristics 2010.