A Case of Beau's Lines at Even Intervals and Onycholysis Caused by Chemotherapy

Abstract

We report a case of Beau's lines at even intervals and onycholysis caused by chemotherapy. The patient with a diffuse large cell B cell lymphoma (DLBCL) stageA underwent combination chemotherapy consisting of R-CHOP (Ri- tuximab, cyclophosphamide, doxorubin, vincristine, predonisolone) every three weeks (21-day intervals) six times. As he was treated with R-CHOP, he noticed each Beau's lines (transverse groove ) on all 20 nails each time. In addition, he had onycholysis caused by cyclophosphamide and doxorubicin treatment. Two months after discontinuation of chemotherapy, Beau's lines disappeared. Beau's line are transverse grooves on the nail surface. They are observed in severe systemic diseases such as measles, Stevens- Johnson syndrome, zinc deficiency, pustular psoriasis, chemotherapy, Kawasaki's disease, pneumonia, telogen efflvium and so on (1). The distance of groove from nail fold is related to the onset of growth disturbance. The depth and width of the groove may be re- lated to the severity and duration of the disturbance (2). The pathomechanism of Beau's line is attributable to temporary arrest of nail matrix formation (1). There are several reported cases of Beau's lines (3, 4) and transverse leukonychia (4) induced by chemotherapy. The 74-year-old man with a history of diffuse large cell B cell lymphoma (DLBCL) was treated with R-CHOP (Rituximab, cyclophosphamide, doxorubin, vincristine, predonisolone) therapy every three weeks. After three cycles of R-CHOP chemotherapy, he noticed transverse grooves on the nail plates and paronychial erythema. At the first dermatological consultation, physical examinations revealed five transverse grooves (Beau's lines) and paronychial erythema (Fig. 1) on all 20 nails after six cycles with R- CHOP chemotherapy. The grooves were 1 to 2mm width with regular borders completely transverse each affected nails. Because he had diabetes mellitus, predonisolone was prescribed 20 mg/day. Laboratory fidings were normal. The patient was diagnosed as Beau's line due to chemotherapy (probably due to cyclophosphamide and doxorubicin). Chemotherapy was discontinued after six cycles. He was treated with topical betamethasone valerate ointment. After two months of discontinuing chemotherapy, the paronychial erythema disappeared. The nail plate was separated from nail bed (onycholysis). Subsequently, Beau's lines disappeared, and then newly nail plate grew. As differen- tial diagnosis, Muehrcke's line was considered. Muehrcke's