Transverse ridging of the nails

Abstract

A 70-year-old man with hormone-refractory prostate cancer who had been treated with three cycles of docetaxel and prednisone chemotherapy presented with three evenly spaced, transverse lines on all of his nails (Fig. 1). Diagnosis of transverse ridging of the nails, also known as Beau’s lines, was made. Beau’s lines are typical signs of acute toxicity to the nail matrix keratinocytes with transient arrest in the nail plate production. The nail shows a transverse depression that migrates distally as the nail grows. These nail abnormalities are not exclusive to drugs, but are commonly seen after trauma or systemic illness. Drug-induced Beau’s lines are usually dose-related and reproducible with re-administration of the drug. Multiple Beau’s lines in the same nail indicate repetitive cycles of drug intake, as illustrated in this patient, and reflect repeated interruptions to the normal rate of nail growth (approximately 0.1 mm per day). There are no preventive measures or treatments, and the changes generally resolve as the nails grow out.