Case Presentation
Chemotherapy Induced Beau’s and Mee’s Line Simultaneously: A Case Report and Review of Literature
Deeptara Pathak Thapa*
Department of Oncodermatology, Nepal Cancer Hospital and Research Centre, Nepal
*Corresponding author: Deeptara Pathak Thapa, Department of Oncodermatology, Nepal Cancer Hospital and Research Centre, Harisiddhi, Lalitpur, Kathmandu, Nepal
Published: 18 Jul, 2018
Cite this article as: Thapa DP. Chemotherapy Induced
Beau’s and Mee’s Line Simultaneously:
A Case Report and Review of
Literature. Clin Oncol. 2018; 3: 1496.
Abstract
Chemotherapy affects skin and its appendages. Nail changes due to chemotherapeutic agents are
common. There are various chemotherapeutic agents implicated for the changes. We report a case
undergoing chemotherapy with etoposide and cyclophosphamide who had beau’s and Mee’s line
simultaneously.
Keywords: Beu’s line, Etoposide, Mee’s line
Introduction
Chemotherapeutics agents can have not only systemic but as well as mucocutaneous side effects.
Nail changes are common like nail dystrophies, chromonychia, leukonychia (including Mee's and
Muehrcke's lines), Beau's lines, paronychia and onycholysis following anticancer drugs [1,2].
Few case reports has been mentioned in the literature of simultaneous appearance of the Mee’s
lines and Beu’s lines in same patient.
Case Presentation
A 20 year girl, diagnosed as Ewing sarcoma receiving chemotherapy including cyclophosphamide and Etoposide presented with multiple white continuous transverse bands with regular intervals covering whole width of nail plates with transverse depressions of fingernails and toenails as Shown in (Figure 1). During chemotherapy cycle white transverse lines moves distally as the nail grew, and new stripes developed after each cycle. She noticed this nail changes after starting of chemotherapy and completed 4 cycles till now. There was no history of any arsenic exposure or any medical illness in our patient. This white line is called Mee’s line and transverse depression is called Beu’s lines. Patient was counseled about the nail changes due to chemotherapy.
Discussion
Nail abnormalities due to result from drug toxicity leads to the matrix, nail bed, periungual
tissues or digital blood vessels involvement. Chemotherapy agents implicated are- vincristine,
hydroxyurea, etoposide, daunorubicin, bleomycin, cyclophosphamide, dacarbazine, 5-fluorouracil
and methotrexate [2-4].
Mee’s lines and Beu’s lines occur due to temporary arrest of proliferative function of the nail
matrix with cytotoxic chemotherapeutic agents. Mee’s lines are signs of toxicity to the distal nail
matrix, disorganized keratinization of the nail matrix leads to Para keratosis of the nail plate, which
becomes white and opaque [5]. True leukonychia (Mee’s lines) due to drug toxicity shows as one or
several parallel transverse white bands affecting all nails at the same level and which moves distally
with nail growth. Leukonychia is seen in arsenic and thallium intoxication and also had been
reported in various medical diseases such as myocardial infarction, acute and chronic renal failure,
kidney allograft rejection, systemic lupus erythematosus, immune hemolytic anemia and Hodgkin's
disease [6]. Beu’s lines are signs of acute toxicity to the nail matrix with transient arrest in nail
plate production due to decrease in matrix cell proliferation which are associated with temporary
cessation of nail growth according to cycles of chemotherapy shows a transverse depression that
migrates distally as the nail grows.
There is difference of proliferative potential between fingernails and toenails which leads to
different clinical manifestations as per Kim et al. Rapid mitotic activity having organs are likely to
damaged more severely from chemotherapy in much the same way fingernails are more vulnerable
to anticancer drugs than toenails but in his case report rapidly proliferating fingernails were less
affected by chemotherapeutic nail matrix damage; consequently,
less severe depression and less opaque Mee’s lines manifested. The
depth of the depression indicates the degree of the damage, and the
width indicates the duration of the insult [7]. We are reporting nail
changes like Beau's line or Mees' line occurring in a same patient after
chemotherapy for the first time from our part of the world. There are
only two case reports, having both Mees lines and Beu’s lines had
been previously reported in the literature till date [7,8]. Nail changes
can be the only symptoms after chemotherapy so a good history,
knowledge about nail changes following chemotherapy, counseling
of the patient and good clinical aquimen is necessary to diagnose such
cases alleviating unnecessary diagnostic workup and treatment.
Figure 1
References
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- Dasanu CA, Vaillant JG, Alexandrescu DT. Distinct patterns of chromonychia, Beau's lines and melanoderma seen with vincristine, adriamycin, dexamethasone for multiple myeloma. Dermatol Online J. 2006;12(6):10.
- Naumann R, Wozel G. Transverse leukonychia following chemotherapy in a patient with Hodgkin's disease. Eur J Dermatol. 2000;10(5):392-4.
- Piraccini BM, Iorizzo M, Tosti A. Drug-induced nail abnormalities. Am J Clin Dermatol. 2003;4(1):31-7.
- Kim IS, Lee JW, Park KY, Li K, Seo SJ, Hong CK. Nail Change after Chemotherapy: Simultaneous Development of Beau's Lines and Mees' Lines. Ann Dermatol. 2012;24(2):238-9.
- Kinjo T, Shibahara D, Higa F, JFujitaKey J. Beau’s Lines and Mees’ Lines Formations after chemotherapy. Intern Med. 2015;54(17):2281.