A hand after chemo with broken nails with white lines

Fingers, Toes, and Nails

Last updated: June 2022

When considering the possible side effects of chemotherapy and blood cancer, one of the first concerns, especially for women and some men, is hair loss. Next are concerns over potential intestinal issues, weight loss due to poor appetite, or yes, weight gain due to hormone changes and other factors.

Didn't worry about this side effect

Few of us give much thought to the impact of chemotherapy on fingernails and toenails.

Before starting some 6 months of chemo, the oncologist casually mentioned that I might see some changes in the color of my nails and that my nails might break more easily and become more brittle.

When you are facing cancer and worrying if it can be cured and silently asking yourself if the cure will be worse than the disease, any thoughts about fingernails are at the bottom of the list.

I learned that patients could experience some changes in nail shape and develop noticeable grooves or ridges. In the back of my head, I am saying... ok, all nice to know, but who cares right now?

The nails might fall off?

The oncologist did get my attention when he casually dropped a comment regarding how some patients can experience isolated incidents of nail separation. “Wait a minute,” I said. “Let's go over that one again.”

I carefully repeat what I heard and translate doctor-speak into English. “So, you are saying I should not be alarmed if my finger and toenails fall off during treatment.”

Can't predict how the body will react to chemo

He nodded and ended our conversation by telling me there is not much one can do about preventing side effects from chemo. It is all about how my body was going to react to the treatments and the only way I would know was to start treatment.

Sure enough, some weeks later I began developing very distinct deep ridges across the base of my fingernails. Over time my fingernails also became weaker and brittle. Small chips would suddenly break off doing simple things like tying shoelaces.

It is interesting how such a small thing like a chip in a fingernail can play on your mind. I was convinced the next step was leaving a trail of fallen nails behind me as I walked through the infusion center. Suddenly mister-who-cares-about-fingernails... is thinking of ways to save them.

A new nail care routine

Here are a few things I learned along the way that  might be helpful to anyone looking to keep their nails healthy for as long as possible when undergoing active chemo, recovering from chemo, or looking to prevent nail damage. Starting with there's not much any of us can do about preventing the side effects of chemo.

  • One of the first things was to keep my nails as short as possible during chemo. I was cautious when clipping and made sure that the edges were both straight and smooth. When cutting nails, I felt it was important not make them too short on the outside edges. Doing so could lead to the development of an ingrown nail which can lead to infection.
  • I tried to prevent dryness by using a good hand cream massaged into the nails and cuticles. And yes, I did toenails as well.
  • Being male I did not have a need for nail polish, but some of the literature I received advised women not to wear nail polish all the time. Apparently, it is best to use only on rare occasions and polish should be removed the same day or the next if possible, using a gentle nail polish remover.
  • The next bit of advice was to wear gloves to help prevent splitting and reduce the chance of getting scratches while doing tasks like gardening or outdoor work. When undergoing chemotherapy, it takes longer for wounds to heal – once again making it easy to develop an infection in your immune-compromised condition.

Nails are still brittle

How long will it take before your nails can recover? My oncologist said it can take anywhere from a few months to well over a year. It has almost been a year since ending chemo and I am still having difficulties with nails breaking and splintering even when short.

Nail polish?

Now comes the dreaded confession. I have started to use a protective coating on my nails to stop the chipping – and yes, it has a slight gloss and it sure looks like I am wearing nail polish. LOL

OK, I guess a little shine on a guy is not so bad after all.

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