When your nails start splitting, lifting or turning odd colours during chemo it can feel like something's gone wrong.
It hasn't. The cells in your nail bed divide fast, which is exactly the sort of cell chemotherapy targets, so nails take a hit alongside hair. Some drugs are harder on them than others, and taxanes have a particular reputation.
Nails grow slowly, which is the frustrating part. A fingernail takes around six months to replace itself completely, and a toenail can take a year or more. What you do now shows up months down the line, so it's worth starting early.
What you might notice
- Brittleness, peeling and splitting
- Ridges or grooves running across the nail
- Dark lines, white marks or a general change in colour
- Nails growing more slowly
- Tenderness or throbbing, particularly in the fingertips
- The nail lifting away from the nail bed, which has the medical name onycholysis
Most of it is temporary and almost everyone gets their nails back.
Keep your nails short during chemo
Short nails snag less, split less and give you far less to catch on a jumper sleeve. If a nail is starting to lift, keeping it short is the most useful thing you can do, because a long lifting nail will eventually catch on something and it really hurts.
Swap your emery board for a glass file
This is the single best small change. Ordinary emery boards have a rough grit that shreds the edge of the nail and encourages splitting. A glass or crystal file has a much finer surface. It seals the edge as it goes rather than tearing it.
How to use one:
- File in one direction rather than sawing back and forth
- Work from the outside edge towards the centre
- Use light pressure and let the file do the work
- Round the corners slightly rather than leaving sharp points
Glass files last for years, they wash under the tap, and they cost a few pounds. Metal clippers can crush a fragile nail, so filing is usually kinder than cutting while you're in treatment.
Oil, oil and more oil
Cuticle oil is the other thing people swear by. Rub it into the cuticle and the nail a couple of times a day, more if you remember. Plenty of people report their nails came through treatment better than expected and put it down to this.
Any nail or cuticle oil will do, or plain almond or jojoba oil if you'd rather keep it simple. Hand cream at the same time helps, because the skin round your nails gets dry too.
Don't cut your cuticles. They're a seal against infection, and with a lower immune system that seal matters more than usual. Push them back gently after a bath if you must, or leave them alone entirely.
Wear rubber gloves when cleaning
Water is the enemy. Long periods of wet weaken the bond between the nail and the nail bed, and detergents strip everything.
Rubber gloves for washing up, cleaning and gardening are ideal. If your hands get sweaty in them, wear thin cotton gloves underneath. It's a dull bit of advice and it makes a genuine difference.
Nail polish, gels and false nails
Gels, acrylics and false nails are best avoided during treatment. There are two reasons: Firstly, they can trap bacteria, and infection is a real concern while your immunity is low. Your team needs to be able to see your nails to spot changes early too. Macmillan's advice is to talk to your cancer team before having any of them, and most units will say no.
If you're currently wearing gels or acrylics and you're about to start treatment, get them professionally soaked off rather than picking at them.
Ordinary nail polish is more of a grey area. Some people find polish protects the nail and stops it catching. There's also evidence that some chemotherapy drugs make nails more sensitive to UV light, which is why a dark polish is sometimes suggested.
The complication is that many chemo units want to see your bare nails during treatment, because nail colour is one of the things they check. Ask your unit what they'd like you to do because it does vary.
If you do wear polish:
- Use a brand you've used before, to reduce the chance of a reaction
- Look for formulas free from formaldehyde and toluene, often labelled 5-free or 10-free
- Take it off with an acetone-free remover, as acetone is very drying
- Remove it as infrequently as you can, so no changing colours twice a week
Nail strengtheners suit some people, though check the ingredients and ask your team before starting anything new.
If a nail starts to lift
Don't pull it off. Ever.
Keep it short, cover it lightly with a plaster or a bit of gauze so it can't catch, and let it come away on its own when it's ready. Ripping a partly attached nail off is both painful and an infection risk.
Tell someone if you notice the following:
- Redness, swelling or heat around the nail
- Pus or discharge
- Pain that's getting worse
- A nail lifting or coming away
- Any change you're unsure about
Nail infections are common during treatment and treatable, particularly if they're caught early. Don't wait for your next appointment.
Ask about cold mitts
Some units offer cooling gloves and socks during certain infusions, which work on a similar principle to a cold cap for your scalp. Availability varies enormously between hospitals.
Before you start supplements
Biotin and various nail vitamins get recommended a lot online. Check with your oncology team before taking anything, because some supplements interfere with treatment. This applies to things that sound completely harmless.
After treatment finishes
Keep going, your nails are still growing out the damaged section for months afterwards, and the ridges and marks will slowly travel up and off the end.
Most people are advised to keep a nail care routine going for at least three months after treatment, and longer does no harm. Hold off on gels and acrylics until your nails have fully grown out and your team is happy.
There's a free hand and nail care workshop run by Look Good Feel Better if you'd like to learn this properly from someone who does it for a living.
Frequently asked questions
Why are my nails weak during chemotherapy? Chemotherapy targets fast-dividing cells, and the cells in your nail bed are among the fastest in the body. That's why nails become brittle, ridged or discoloured during treatment.
Is a glass nail file better for chemo nails? Yes, most people find it much gentler. A glass file has a fine surface that seals the nail edge, while a rough emery board tears at it and encourages splitting. File in one direction rather than sawing.
Can I wear nail polish during chemotherapy? Ordinary polish is often fine, but ask your unit first, as some want to see bare nails during treatment. Use an acetone-free remover and a formula free from formaldehyde and toluene.
Can I have gel nails or acrylics during chemo? It's generally advised against. They can trap bacteria when your immunity is low, and they stop your team seeing nail changes. Talk to your cancer team before having any.
How long do nails take to recover after chemotherapy? Fingernails take around six months to grow out completely, and toenails can take a year or more. Keep your nail care routine going for at least three months after treatment ends.
Not medical advice. Tell your oncology team about any nail changes, and check with them before starting new products or supplements.
