Nail Changes During Treatment With Taxanes

This information describes nail changes that you may experience while taking taxanes and how to manage these changes.

Your fingernails and toenails may change if you are taking a class of chemotherapy medication known as taxanes. The medications that most often cause these changes are:

  • Docetaxel (Taxotere®)
  • Paclitaxel (Taxol®)
  • Albumin-bound paclitaxel (Abraxane®)
  • Capecitabine (Xeloda®)
  • Pegylated doxorubicin (Doxil®)


You may have any of the following symptoms in your nails:

  • Discoloration in nails (dark or light)
  • Grooves or ridges
  • Brittle nails and changes in nail shape or texture
  • Nail splitting
  • Nail separation from the skin below, which may or may not be painful
  • Discharge or fluid from under the nail, which may or may not be an infection. It may be foul-smelling and painful.
  • Swelling in the tips of your fingers or toes
  • Slow nail growth
  • Growth on the side of your nails

These nail changes can involve the nail plate, nail bed, the area around the nail or under the nail, or all of these areas (see Figure 1).

Figure 1. Nail anatomy

These changes may stop you from doing your usual activities. It may be hard to pick up small things such as a pen or a fork. You may have trouble buttoning your clothes. Some people have trouble walking.

For some taxanes, the risk of developing side effects is very high. For others, the risk is much lower. Symptoms can start as early as 3 to 6 weeks after treatment begins. Symptoms usually go away when:

  • The dose of the medication is lowered.
  • Treatment is stopped.

It takes about 6 months to regrow a fingernail and about up to 1.5 years to regrow a toenail. Your new nails will usually look normal but may regrow abnormally.  

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Managing Your Symptoms

Tell your doctor or nurse as soon as you begin to have any symptoms of nail changes. Follow the suggestions below to manage these symptoms.

Do not:

  • Soak your hands and feet in hot water or hot tubs, or take hot baths.
  • Wear tight-fitting gloves, socks, pantyhose, or shoes.
  • Do anything that would cause friction or pressure to your nails, such was walking long distances or wearing tight-fitting shoes.
  • Bite or peel your nails.


  • Tell your doctor if you have diabetes, vascular disease, peripheral neuropathy, autoimmune disease, as this may increase the risk of skin breakdown, wound healing and infection.
  • Tell your doctor if you are having pain or changes in or around your nails. Your doctor may prescribe medications to treat the area such as topical steroids, topical antimicrobials and topical pain medications. Topical medications are those that you apply on your skin. If your symptoms become worse, your doctor may prescribe oral medications (by mouth).
  • Ask your doctor or nurse if you can place cold packs on your hands and feet when you are getting your medication. If the answer is yes, start using them 15 minutes before and keep them on until 15 minutes after the infusion of medication.
  • Keep your hands and feet well moisturized with fragrance-free creams or ointments. Try thick creams or ointments, such as:
    • Eucerin®
    • Aquaphor®
    • Vaseline®
    • Bag Balm®
    • Udderly Smooth®
    • Cetaphil®
    • CeraVe®
    • Vanicream®
    • Vaseline® Intensive CareTM
  • Wear soft, padded shoes or slippers. Examples are Tempur-Pedic® slippers and Crocs®.
  • Wear soft, cushioned, cotton socks with all your shoes.
  • Wear white cotton gloves when carrying objects, doing physical work, or playing sports.  You can use vinyl gloves for dishwashing.
  • Keep nails short with smooth edges using a nail clipper and file.
  • Speak with your doctor or nurse about your nail health and ask if you can get manicures or pedicures at salons. 

Other suggestions 

Your doctor may also recommend that you:

  • Use biotin (Appearex®) for brittle nails.
  • See a podiatrist if necessary. A podiatrist is a doctor who treats conditions of the foot, ankle, and leg. 
  • Soak your fingers or toes in a mixture of equal parts white vinegar and tap water for 15 minutes every night, if you have any signs or symptoms of infection. Signs or symptoms of infection include:
    • Redness
    • Drainage that may or may not be odorous
    • Skin that is warm, hot, painful or hard to the touch
    • A temperature of 100.4° F (38° C) or higher
    • Chills

Call your doctor if you have any signs or symptoms of infection.

Your doctor may culture (scrape the nail to check for bacteria) or clip your nail to see if you have a bacterial or fungal infection that is causing these nail symptoms.

If your symptoms persist or get worse and become difficult to manage, your doctor may remove the entire nail to control the pain and clean the nail bed.

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