Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(3):e2023159 1

Docetaxel-Induced Nail Bed Purpura
Arunachalam Narayanan1, Devinder Mohan Thappa1, Balasundaram Mithin Kumar1

1 Department of Dermatology and STD, JIPMER, Puducherry, India

Citation: Narayanan A, Thappa DM, Mithin Kumar B. Docetaxel-Induced Nail Bed Purpura. Dermatol Pract Concept. 
2023;13(3):e2023159. DOI: https://doi.org/10.5826/dpc.1303a159

Accepted: December 15, 2022; Published: July 2023

Copyright: ©2023 Narayanan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Dr. Arunachalam Narayanan, MD, Senior Resident, Department of Dermatology and STD, JIPMER, 
Puducherry-605006. E-mail ID: narayanan359@gmail.com

Case Presentation

A 57-year-old male patient presented to our outpatient 

clinic with reddish discoloration of the nail plates. He was a 

known case of moderately differentiated adenocarcinoma of 

the stomach and was on treatment with docetaxel-based che-

motherapy (docetaxel 75 mg/m2 and oxaliplatin 130 mg/m2 

on day 1 followed by capecitabine 1000 mg/m2 orally twice 

daily on days 2-14) for the last 2 months. Examination of his 

nails revealed subungual onycholysis of his bilateral great 

toes along with nail bed purpura over the third right toe 

and multiple fingernails (Figure 1A). Dermatoscopy revealed 

presence of circumscribed red homogenous blotches on mul-

tiple fingernails (Figure 1B). Based on the above features, we 

made a diagnosis of docetaxel-induced nail bed purpura and 

subungual onycholysis.

Teaching Point

Docetaxel is a semisynthetic analogue of paclitaxel that acts by 

binding to beta tubulin subunit of microtubule resulting in its 

disassembly. Nail changes seen post-treatment with docetaxel-

based chemotherapy include onychomadesis, onycholysis, 

beau’s lines, paronychia, and nail bed purpura [1]. The direct 

toxic insult to the nail bed epithelium results in the formation 

of hemorrhagic bulla and onycholysis [2]. Secondary infection 

of the collected blood can also be present, which may present 

as intense pain due to pressure effect. Under dermatoscopy, 

hemorrhages would appear as presence of globules of varying 

colors including purple, violet, and red. Management includes 

antibiotics for the treatment of paronychia. Nail bed purpura 

resolves spontaneously after treatment is stopped.

References

1. Capriotti K, Capriotti JA, Lessin S, et al. The risk of nail changes 

with taxane chemotherapy: a systematic review of the literature 

and meta-analysis. Br J Dermatol. 2015;173(3):842-845. DOI: 

10.1111/bjd.13743. PMID: 25704465.

2. Roh MR, Cho JY, Lew W. Docetaxel-induced onycholysis: the 

role of subungual hemorrhage and suppuration. Yonsei Med J. 

2007;48(1):124-126. DOI: 10.3349/ymj.2007.48.1.124. PMID: 

17326255. PMCID: PMC2628000.



2 Image Letter | Dermatol Pract Concept. 2023;13(3):e2023159

Figure 1. (A) Nail bed purpura over fingernails. (B) Dermatoscopy revealing presence of circumscribed red homogenous blotches on 

fingernails.