DOI: 10.1097/jd9.0000000000000480 ISSN: 2096-5540

Skin, hair, and nail manifestations following an anthracycline-based chemotherapy regimen and associated risk factors: a preliminary prospective study

Dini Daniaty, Larisa Paramitha Wibawa, Aida SD Hoemardani, Andika Rachman, Muhammad Ilyas, Endi Novianto
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Objectives:

Skin, hair, and nail (SHN) manifestations are common adverse effect of chemotherapy and can impair the quality of life of patients with cancer. However, little is known about their incidence among patients receiving anthracycline-based chemotherapy or about the factors associated with them. We therefore conducted this study to explore SHN manifestations and their associated risk factors through the first two cycles of anthracycline-based chemotherapy.

Methods:

A prospective single-arm observational study was conducted from April–September 2023. No control group was included. All adult patients who received the first episode of an anthracycline-based regimen were enrolled and followed until the second cycle. We recorded age, sex, systemic comorbidity, body mass index (BMI), Eastern Cooperative Oncology Group performance status, hemoglobin level, and chemotherapy dose. Numerical variables were compared using the independent-samples t -test or the Mann-Whitney U test, as appropriate, and proportions using the chi-square test or Fisher’s exact test. Variables with p < 0.25 on bivariate tests were entered into a multiple logistic regression analysis.

Results:

Of 65 patients included in the final analysis (mean age 45.45±11.90 years; 75.4% female), all developed SHN manifestations (100.0%). The most frequent manifestations were anagen effluvium (89.2%), melanonychia (87.7%), xerosis (58.5%), and hyperpigmentation (50.8%). The earliest manifestation to appear was xerosis, followed by anagen effluvium. On bivariate analysis, patients who had melanonychia had higher BMI than those without (23.90±3.99 vs. 20.22±4.75 kg/m 2 ; P = 0.020), and patients with hair manifestations had a higher median chemotherapy dose than those without. No association was found between SHN manifestations and older age, systemic comorbidity, nutritional status, performance status, anemia, or chemotherapy dose. Exploratory regression analysis showed that female (adjusted odds ratio [aOR] 8.45, 95%CI 1.86–38.45; P = 0.006) and anemia (aOR 5.09, 95%CI 1.25–20.79; P = 0.024) were more prone to xerosis.

Conclusion:

Among patients receiving anthracycline-based chemotherapy in this study, all developed SHN manifestations. Patients with nail manifestations had a higher BMI, and patients with hair manifestations had a higher median chemotherapy dose. In exploratory analyses, female sex and anemia were associated with xerosis.

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