Mycophenolate-Associated Onycholysis
Authors: Raymond Rault
Journal: Annals of Internal Medicine (2000)

Letters5 December 2000Mycophenolate-Associated OnycholysisRaymond Rault, MDRaymond Rault, MDUniversity of Pittsburgh Medical Center Health System; Pittsburgh, PA 15261 (Rault)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-133-11-200012050-00023 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I was interested to read the report of skin changes associated with mycophenolate mofetil (1). Although skin changes are not recognized side effects of this drug, I recently encountered a patient in whom mycophenolate was associated with onycholysis.A 45-year-old man underwent cadaveric renal transplantation after having undergone hemodialysis for 19 years. Immunosuppressive therapy consisted of tacrolimus, prednisone, and mycophenolate mofetil. The dosage of mycophenolate was 1 g twice daily for 1 week and then 500 mg twice daily. Three weeks later, the patient reported blisters on one hand and loose toenails. Mycophenolate therapy was stopped, and the symptoms improved. After therapy with the drug resumed, however, hand blisters and loose toenails recurred; eventually, one nail was lost. A third attempt to use the drug at a lower dosage (250 mg twice daily) was associated with loss of toenails but no further blisters.Premature separation of the nail plate is usually due to trauma, but reports have described this disorder complicating chemotherapy for cancer (2). It is perhaps not surprising that a drug that inhibits purine nucleotide synthesis should have similar adverse effects.Indications for the use of mycophenolate mofetil have widened in recent years. In addition to its widespread use in renal transplantation (3), the drug has also been given to a small number of patients with systemic lupus erythematosus, glomerulonephritis, dermatomyositis, and Crohn disease. Because these diseases may have skin manifestations, it is important to be aware that the drug itself may have side effects that will confuse the clinical picture unless this potential effect is recognized promptly.References1. Semhoun-Ducloux S, Ducloux D, Miguet JP. Mycophenolate mofetil-induced dyshidrotic eczema [Letter]. Ann Intern Med. 2000;132:417. LinkGoogle Scholar2. Makris A, Mortimer P, Powles TJ. Chemotherapy-induced onycholysis [Letter]. Eur J Cancer. 1996;32A:374-5. CrossrefMedlineGoogle Scholar3. Warrens AN. The evolving role of mycophenolate mofetil in renal transplantation. QJM. 2000;93:15-20. CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: University of Pittsburgh Medical Center Health System; Pittsburgh, PA 15261 (Rault) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMycophenolate Mofetil-Induced Dyshidrotic Eczema Sylvie Semhoun-Ducloux , Didier Ducloux , and Jean-Philippe Miguet Metrics Cited byNail changes in upper extremity allotransplantation: onychomadesis as the presenting sign of allograft rejection – a retrospective studyMycophenolate mofetilNail changes in female pemphigus vulgaris patients on immunosuppressive therapyUpdate on Benign and Inflammatory Skin Disease Secondary to Transplant MedicationLate Nail Lesions Rejection in a Stable Bilateral Forearm Allograft at 60 Months PosttransplantationNon-Malignant and Malignant Skin Lesions in Kidney Transplant PatientsNonneoplastic mucocutaneous lesions in organ transplant recipientsIMMUNE MODULATORSMycophenolate mofetil in dermatologyAtypical Acute Rejection After Hand TransplantationOnychopathie associée au sirolimus chez les transplantés rénauxMycophenolate mofetilMycophenolate mofetil and skin diseasesCutaneous Adverse Events in Renal Transplant Recipients Receiving Sirolimus-Based Therapy1Systemic DrugsMycophenolate mofetil and skin diseasesOnicólisis inducida por fármacosDrugs acting on the immune systemMycophenolate mofetil: First report of onycholysis: case report &OV0325; 5 December 2000Volume 133, Issue 11Page: 921-922KeywordsAdverse reactionsBlistersCancer chemotherapyDrug therapyDrugsImmunosuppressivesLupus erythematosusPurinesRenal transplantationSkin diseases ePublished: 5 December 2000 Issue Published: 5 December 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...