How to Prepare and Care for Your Nails During Breast Cancer Treatment

Certain breast cancer treatments can cause changes, breakage, and irregular growth in the nails. You can take steps to care for your nails to help prevent some of these side effects.

There can be multiple side effects from treatment for breast cancer, including triple-negative breast cancer (TNBC). One of these side effects can be fingernail and toenail changes.

These changes don’t come from the type of breast cancer you have but from the treatments themselves. They can happen in one, a few, or all of your nails and can vary in severity.

It can help to know what to expect and how to manage nail changes while undergoing treatment. Read on to learn more.

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Why do nail changes happen during cancer treatment?

The nail is a complex structure. Changes can happen when cells in one or more parts of the nail become damaged or modified.

Depending on the treatment, changes can occur in the nail plate, the nail bed, and other parts of the nail. Some changes start as soon as you begin treatment, while others may take months to become noticeable.

For example, certain chemotherapy drugs can alter the rate of cell division or keratin production in the nail matrix, the tissue at the base of each nail that leads to nail growth.

When the nail matrix stops working normally, the nails may change color, become more brittle or thin, or grow in an irregular formation.

Which treatments can lead to nail changes?

Treatments for TNBC and other types of cancer that can cause nail changes include chemotherapy, radiation therapy, and targeted therapies.

Depending on the treatment, you might experience several symptoms, including:

• nail discoloration
• cracks in your nails
• pain or swelling in your cuticles
• lifting of the nails
• nail infections
• nail loss

Nail changes during cancer treatment are most often due to chemotherapy medications, but targeted therapies can also cause them.

Some of these changes may go away quickly, while some may take longer as your nails slowly grow out. Others may be permanent.

Chemotherapy

If you’re undergoing chemo, your nails may darken and become cracked. Some people experience pain in their cuticles.

Various types of chemotherapy for breast cancer, including TNBC, can cause nail changes.

These include:

• Adriamycin (doxorubicin, Doxil): This can cause creases, ridges, lines, inflammation in the skin around the nail, thin lines of blood under the nail called splinter hemorrhages, and darkening of the nails, also called hyperpigmentation.
• Daunorubicin (brand names DaunoXome and Cerubidine): This can cause the nail bed to lift, called onycholysis.
• Ixempra (ixabepilone): Not much is known about its effects on nails, but one older case study reported nail separation from the bed and bleeding under the fingernails.
• Mitoxantrone (Novantrone): This can cause nail changes including separation from the nail bed.
• Taxotere (docetaxel): This can cause lines, ridges, creases, splinter hemorrhages, and inflamed skin around the nail.

Targeted therapies

Nail changes caused by specific targeted therapies for TNBC include:

• EGFR inhibitors, like erlotinib and gefitinib, can cause hyperpigmentation and inflammation around the nail.
• mTOR inhibitors, like everolimus and temsirolimus, can cause the nail to lift.

Immunotherapy

Treatment for TNBC sometimes includes immunotherapy, which can also come with nail changes.

These include:

• Monoclonal antibodies, like panitumumab, can cause grooves or fissures in the nails, hyperpigmentation, and redness and inflammation in the skin around the nail.
• Immune checkpoint inhibitors, like pembrolizumab, can cause the nail to lift from the nailbed, inflammation of the skin around the nail with scaling of the skin, and subtle pitting in the nail.

Hormone therapies

Hormone therapies like tamoxifen do cause nail changes, but they’re used to treat hormone-sensitive types of cancer — not TNBC.

TNBC cells are not hormone-sensitive because they don’t have estrogen or progesterone receptors, so they don’t respond to these drugs.

Note: Radiation can cause nail darkening, but this isn’t the case if radiation is targeted to the breasts.

How can you manage nail changes during and after treatment?

You can take steps to manage nail changes while you’re receiving cancer treatment to keep your nails looking and feeling their best.

1. Monitor daily: Check your fingernails and toenails for any changes and write them down to share with your healthcare team. Tell a healthcare professional right away if you have symptoms of infection, like hot, red, inflamed skin around the nail.
2. Lacquer: Apply a water-based lacquer, especially to delicate areas and edges that may be prone to splitting. This will help strengthen and reinforce the nails to prevent further damage.
3. Trim regularly: Maintaining nail length helps reduce the risk of infection and breakage.
4. Take care of your cuticles: Consider using cuticle cream to gently remove the cuticle or a moisturizing cream to keep them soft.
5. Wear gloves: Many hands-on activities can dry the skin and cuticles, or increase the risk of infection or breakage. Use gloves especially when working with your hands, like gardening or cleaning.
6. Use sanitized nail tools: This will help reduce the risk of infection. If you go to a nail salon, take your sanitized tools with you and ask the staff to use them during your session.
7. Avoid using artificial nails: They can trap bacteria and increase your risk of infection, and the chemicals they contain may cause an allergic reaction.
8. Apply a cold pack before receiving a taxane drug: Put the cold pack on your nails 15 minutes before you receive a dose and leave it on until 15 minutes after to help prevent the nails from lifting.
9. Consider taking biotin: Biotin is a supplement that can help strengthen your nails. Speak with your doctor to see if it’s safe for you.

Keep an eye out for other symptoms that may be related to your treatment.

These can include:

• skin darkening
• peeling, dry skin
• inflammation and swelling
• itching
• rash
• sores or acne

Other causes

You might experience nail changes during treatment for TNBC from other related factors.

For example, cancer treatments and some cancers themselves can lead to nutrient deficiencies, which can cause nail changes.

Infections may cause changes to the nail as well, so it’s important to take steps to prevent them.

Frequently asked questions

Here are some answers to frequently asked questions about breast cancer and your skin and nails.

Does breast cancer affect your fingernails?

Breast cancer itself does not affect your fingernails, but many treatments can. These include:

• chemotherapy
• hormone therapies
• immunotherapy
• various targeted treatments

Certain cancers directly affect fingernails, like subungual melanoma, a rare form of skin cancer. Signs of this cancer in fingernails include brown-black streaks or discoloration of the tissue under the nail, especially when the discoloration also affects the surrounding skin.

Does chemo affect your fingernails?

Chemotherapy drugs can have short and long-term effects on your fingernails. The effects you’ll see depend on the drug.

They include:

• ridges
• creases
• lines
• splinter hemorrhages
• darker nail color
• inflammation of the skin around the nail
• lifting of the nail bed
• nail loss

It may not be possible to prevent changes, but you can take steps to help keep the nails from breaking or becoming infected.

What does TNBC of the skin look like?

Triple-negative breast cancer (TNBC) and other types of breast cancer grow inside the breast, not on the skin.

However, people with breast cancer, including those with TNBC, may experience breast skin changes like dimpling or puckering.

Takeaway

If you’re going through treatment for TNBC, you might notice changes in your fingernails, toenails, and surrounding skin.

Nail changes are a common side effect of many radiation, chemotherapy, and targeted treatments.

Some nail changes can be permanent, but after treatment ends, many nail changes go away and healthy nails typically regrow.