Adverse event management: paronychia

Management recommendations¹

Grade 1:

Continue GIOTRIF^® (afatinib) treatment at current dose
Topical antibiotics or antiseptics*, vinegar soaks** and topical ultrapotent steroids should be considered

Grade 2:

Continue GIOTRIF^® (afatinib) treatment at current dose
Topical antibiotic*, vinegar soaks** and topical ultrapotent steroids
Weekly application of silver nitrate

Grade ≥3 or intolerable Grade 2:

Refer to a dermatologist
Interrupt GIOTRIF^® (afatinib), resuming treatment at a reduced dose (10mg lower) if patient recovers to grade ≤1. Permanent discontinuation should be considered in patients who cannot tolerate 20 mg/day of GIOTRIF^® (afatinib) treatment
Topical antibiotics* and vinegar soaks**
Weekly application of silver nitrate
Nail avulsion and systemic antibiotics should be considered

Advice for patients²

Avoid biting nails, overly aggressive manicures/pedicures and nail trauma
Avoid contact with irritating substances and prolonged exposure to water
When it is necessary to wear vinyl gloves, cotton gloves should be worn underneath
High risk patients should take extra care to ensure their nails are kept dry and clean. These include:
- Patients repeatedly exposed to moist environments, e.g. housekeepers, swimmers
- Diabetic and immunosuppressed patients who may be more prone to infections

Grading³

The paronychia grading system can be used to steer management strategy.

Grade 1	Grade 2	Grade 3
Nail fold oedema or erythema; disruption of the cuticle	Localised intervention indicated; oral intervention indicated (e.g., antibiotic, antifungal, antiviral); nail fold oedema or erythema with pain; associated with discharge or nail plate separation; limiting instrumental ADL^a	Surgical intervention or IV antibiotics indicated; limiting self-care ADL^b

Grade 1	Nail fold oedema or erythema; disruption of the cuticle
Grade 2	Localised intervention indicated; oral intervention indicated (e.g., antibiotic, antifungal, antiviral); nail fold oedema or erythema with pain; associated with discharge or nail plate separation; limiting instrumental ADL^a
Grade 3	Surgical intervention or IV antibiotics indicated; limiting self-care ADL^b

Adapted from CTCAE version 3.³

*Topical antibiotics/antiseptics include: clindamycin 1%, chloramphenicol 1% and iodine ointment

**Vinegar soaks consist of soaking fingers or toes in a solution of white vinegar in water 1:1 for 15 minutes every day

^aInstrumental ADL=preparing meals, shopping for groceries or clothes, using the telephone, managing money, etc.

^bSelf-care ADL=bathing, dressing and undressing, feeding self, using the toilet, taking medications, and not bedridden

AE=adverse event

References

1: Lacouture ME, et al. Expert Rev Anticancer Ther 2013;13(6):721–728.
2: Aw DC, et al. Asia-Pac J Clin Oncol 2018;14(1):23–31.
3: Common Terminology Criteria for Adverse Events (CTCAE) Version 3

You may also be interested in...

Indication

GIOTRIF^® (afatinib) in an irreversible ErbB inhibitor approved in non-small-cell lung cancer. Find out how your patients could benefit.

Learn more

Dosing

GIOTRIF^® (afatinib) dose modification can be an important strategy to help manage adverse reactions.

Learn more

This site uses cookies to improve your browsing experience. By using this site, you agree to their use.

Cookie policy

Disclaimer

You're now leaving our website...

Using this link will let you leave a website of Boehringer Ingelheim International GmbH (“BI”) or to a different domain under the control of BI. In the event that the linked site is not under the control of BI but under the control of a third party or an affiliate in the Boehringer Ingelheim group of companies, BI shall not be responsible for the contents, processing of personal data of any linked site or any link contained in a linked site, or any changes or updates to such sites. This link is provided to you only as a convenience, and the inclusion of any link does not imply endorsement by BI of the site.

Do you want to continue?

Continue Cancel