From the Research
Management of a detached toenail in a patient with stage 4 sarcoma undergoing chemotherapy requires careful attention to prevent infection due to the patient's immunocompromised state. The primary approach involves gentle cleansing of the affected area with sterile saline or mild antiseptic solution like chlorhexidine 0.5%, followed by application of a topical antibiotic such as mupirocin 2% ointment three times daily 1. The toe should be covered with a sterile, non-adherent dressing (such as Telfa) and changed daily or whenever soiled. If the nail is partially attached but loose, it should not be forcibly removed but may be carefully trimmed to prevent catching and further trauma. Pain management can include acetaminophen 500-1000mg every 6 hours as needed, avoiding NSAIDs which may interact with chemotherapy. The patient should elevate the foot when possible and monitor closely for signs of infection including increased pain, redness extending beyond the toe, purulent discharge, or fever, which would necessitate immediate medical attention and likely systemic antibiotics. Some key points to consider in the management of nail changes due to chemotherapy include:
- Nail changes are common side effects of chemotherapy, with a study finding that 71.3% of patients experienced nail changes 2
- The most common nail changes observed were chromonychia and nail dystrophy 2
- Early recognition and treatment of nail toxicities can minimize their impact and allow better adherence to oncologic treatments 1 Prophylactic oral antibiotics are generally not recommended unless signs of infection develop, as they may disrupt normal flora and lead to opportunistic infections. The patient should be advised to wear open-toed shoes or sandals until healing occurs, which may take 3-6 months for complete nail regrowth. It is also important to note that the management of a detached toenail in a patient with stage 4 sarcoma undergoing chemotherapy should be individualized and take into account the patient's overall health and treatment plan, as well as any potential interactions between medications 3, 4.