METHODS


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An IRB waiver was obtained to perform a retrospective chart review. A retrospective review of all cases presenting to a single private dermatology private practice from June 2016 to January 2017 identified nine patients with chemotherapy-associated paronychia seeking treatment. Patients with recalcitrant chemotherapy-associated paronychia were referred from local oncology offices. Previous treatment modalities prescribed by oncology were discontinued. Each patient was prescribed a topical solution comprised of 2% povidone–iodine (PVP-I) in a dimethylsulfoxide (DMSO) vehicle that was prepared by a licensed compounding pharmacy. The patient was instructed to apply the solution twice daily to the nail folds, nail plate, and subungual space. Patients typically returned to the office at 3 week intervals with number of nails involved being recorded at each visit. Adverse effects were evaluated at each visit. Paronychia was inclusive of periungual edema, erythema, exudate, onycholysis with or without subungual abscess, and periungual or subungual granulation tissue. Bacterial and fungal cultures were performed at baseline visit as well.

RESULTS

All 9/9 patients demonstrated complete or partial resolution within 6 weeks of therapy. Seven patients were classified as CTCAE grade 2 and two patients as grade 3 at treatment initiation, and each of the patients demonstrated improvement and CTCAE downgrading during treatment. Four patients had finger-only involvement, four patients had toe-only and one patient had mixed involvement of both fingers and toes. The number of nails involved for each patient ranged from 4–12. There were a total of 58 nails affected in the series of all cases, and 44/58 (76%) completely resolved. Complete resolution of paronychia occurred in 3/9 (33%) patients, and partial resolution occurred in 6/9 (66%) of patients. Of the nine patients, 4/9 (44%) received taxanes and 5/9 (56%) received EGFR inhibitors. For the patients receiving taxanes who developed paronychia, all four patients had a partial response. All 4/4 patients demonstrating partial response at the 6 week follow-up had at least one nail with residual onycholysis, which was counted as a treatment failure. The other nail morbidities including erythema, edema, exudate, and subungual suppuration demonstrated downgrading. Of the patients receiving EGFR inhibitors, three patients had complete response (all at the 3 week visit) and two patients had partial responses. Patients receiving taxanes and EGFR inhibitors with a partial response (6/6) did not return after the 6 week visit as pain had greatly subsided and they resumed ADL. Mild irritation at application site was noted in 2/9 (22%) of patients but did not affect application schedule. All 9/9 patients subjectively reported resolution of nail unit pain within 2–7 days, and none required chemotherapy dose modification or discontinuation by oncology while using topical therapy. None of the patients reported stinging or burning at application site. All 9/9 (100%) of patients had positive fungal and/or positive bacterial cultures at baseline (Table 1).

(To view a larger version of Table 1, click here.)