A rare manifestation of nail changes with docetaxel therapy

A 60-year-old African American man presented to the dermatology clinic for evaluation of skin and nail changes associated with docetaxel therapy for adenocarcinoma of the prostate. Previous treatment cycles ofdocetaxel had resulted in hyperpigmented patches and linear streaks on his arms where he received infusions, as well as nail changes, including longitudinal melanonychia and onycholysis of his great toenails. At his latest visit, he reported recently noticing a new bluish discoloration of his lunulae that had developed during the past 3 months, the time corresponding to his most recent docetaxel treatment cycle (Figure). The patient's history did not reveal any recent medication changes, ingestion of known lunula-discoloring agents, or any silver-containing compounds. On examination, the patient's observation was confirmed, as the lunulae on both his right and left thumb were found to have a marked blue discoloration to them. The patient was treated with observation as the discoloration was not bothersome to him, and on routine follow-up for an unrelated skin complaint, the patient's nail beds had returned to their normal color, approximately 3 months after discontinuation of the docetaxel therapy, according to the patient.