Drug-induced nail pigment - Nail and Distal Digit
Alerts and Notices
Synopsis
Cancer chemotherapeutic agents may result in melanonychia and leukonychia 1-2 months from the start of treatment. Doxorubicin can produce leukonychia and melanonychia within the same nail. Melanonychia is most often due to cyclophosphamide, doxorubicin, and hydroxyurea. Longitudinal bands, diffuse nail pigmentation, and associated skin pigmentation may be seen. The nail changes are due to activation of melanocytes within the nail matrix.
True leukonychia (due to faulty keratinization of the distal nail matrix) may be seen with treatment with antimetabolites including doxorubicin, cyclophosphamide, and vincristine. Apparent leukonychia (due to defects in nail bed blood flow) may also occur with chemotherapy. Some drugs, such as doxorubicin, can cause the occurrence of both leukonychia and melanonychia in the same nail.
Minocycline may occasionally cause abnormal pigmentation of the nails, and may also involve the skin, skin, teeth, mucosa, and sclera. It is thought to occur at cumulative doses greater than 100 g. It typically causes blue-black or slate-gray pigmentation of the proximal nail bed. Psoralen plus UVA (PUVA) therapy may result in longitudinal, transverse, or diffuse melanonychia, more often with 8-methoxypsoralen (8-MOP) than with 5-MOP.
Azidothymidine (AZT) may cause a number of different patterns of nail pigmentation including bluish-to-brown, diffuse nail discoloration, transverse or longitudinal banding, and a faint blue pigmentation of the lunulae.
Greenish florescence of nails has been reported after favipiravir, an antiviral medication given for COVID-19 infection.
Related topics: Longitudinal melanonychia, Leukonychia, Minocycline drug-induced pigmentation
Codes
ICD10CM:T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter
SNOMEDCT:
110284009 – Drug-induced pigmentation
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Melanoma and acral lentiginous melanoma will typically involve one nail.
- Melanonychia can be a variant of normal in individuals with darker skin pigmentation.
- Onychomycosis
- Pseudomonas nail infection
- Exogenous pigment (tobacco, tar, silver nitrate)
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:05/24/2018
Last Updated:11/22/2021
Last Updated:11/22/2021
Drug-induced nail pigment - Nail and Distal Digit