Introduction: Transverse melanonychia, characterized by grey to black pigmented bands traversing the nail plate, can occur as a side-effect of certain medications. While no documented reports specifically associate dasatinib, a tyrosine kinase inhibitor used in the treatment of chronic myeloid leukaemia (CML) and acute lymphoblastic leukaemia, with nail changes, we present a case of transverse melanonychia possibly related to dasatinib therapy. Case Report: A 54-year-old male with CML, receiving dasatinib for 1.5 years, presented with transverse pigmented lines involving all fingernails and toenails. Clinical examination revealed discrete bands of transverse melanonychia in the nails. Onychoscopy of all finger- and toenails revealed multiple longitudinal grey lines within transverse grey bands of homogeneous chromonychia. Based on clinical presentation, onychoscopic features, and temporal association with dasatinib therapy, a provisional diagnosis of dasatinib-induced transverse melanonychia was made. Discussion: The exact mechanisms underlying melanonychia are not fully understood but may involve nail matrix or toxicity, stimulation of nail-matrix melanocytes, or drug deposition within the nail plate. This case highlights the possibility of dasatinib-induced transverse melanonychia and underscores the importance of monitoring and evaluating nail changes in patients undergoing dasatinib treatment.

Journal Section:
Novel Insights from Clinical Practice
Keywords:
Dasatinib, Transverse melanonychia, Chemotherapy-induced nail change, Onychoscopy, Drug-induced melanonychia
1.
Brazzelli V, Grasso V, Borroni G. Imatinib, dasatinib and nilotinib: a review of adverse cutaneous reactions with emphasis on our clinical experience. J Eur Acad Dermatol Venereol. 2013;27(12):1471–80.
https://doi.org/10.1111/jdv.12172
2.
Ng CF, Tan HJ, Remli R. Chemotherapy-induced transverse melanonychia. BMJ Case Rep. 2021;14(8):e245878.
https://doi.org/10.1136/bcr-2021-245878
3.
Osemwota O, Uhlemann J, Rubin A. Twenty-nail transverse melanonychia induced by hydroxyurea: case report and review of the literature. J Drugs Dermatol. 2017;16(8):814–5.
4.
Das A, Podder I, Kumar D, Ghosh A, Shome K. Imatinib-induced transverse melanonychia: an unusual presentation. Indian J Dermatol. 2015;60(4):412–3.
https://doi.org/10.4103/0019-5154.160500
5.
Pellicane BL, Rashid RM. Transverse melanonychia after radiation therapy. Cutis. 2010;85(5):239–41.
6.
Quinlan KE, Janiga JJ, Baran R, Lim HW. Transverse melanonychia secondary to total skin electron beam therapy: a report of 3 cases. J Am Acad Dermatol. 2005;53(2 Suppl 1):S112–4.
https://doi.org/10.1016/j.jaad.2004.11.020
7.
Paurobally D, El Hayderi L, Richert B, Andre J, Nikkels AF. Melanotan-associated transverse melanonychia. J Eur Acad Dermatol Venereol. 2013;27(1):128–9.
https://doi.org/10.1111/j.1468-3083.2011.04399.x
8.
Lang K, Groeger M, Neumann NJ, Ruzicka T, Fritsch C. Supravenous hyperpigmentation, transverse leuconychia and transverse melanonychia after chemotherapy for Hodgkin’s disease. J Eur Acad Dermatol Venereol. 2002;16(2):162–3.
https://doi.org/10.1046/j.1468-3083.2002.00424.x
9.
Singal A, Bisherwal K. Melanonychia: etiology, diagnosis, and treatment. Indian Dermatol Online J. 2020;11(1):1–11.
https://doi.org/10.4103/idoj.IDOJ_167_19
10.
Levêque D, Becker G, Bilger K, Natarajan-Amé S. Clinical pharmacokinetics and pharmacodynamics of dasatinib. Clin Pharmacokinet. 2020;59(7):849–56.
https://doi.org/10.1007/s40262-020-00872-4
11.
Boudadi K, Chugh R. Diffuse hypopigmentation followed by hyperpigmentation in an african american woman with hemangiopericytoma treated with dasatinib. J Clin Diagn Res. 2014;8(11):QD01–2.
https://doi.org/10.7860/JCDR/2014/8055.5160
© 2023 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2023
You do not currently have access to this content.