Gefitinib-Induced Paronychia: Response to Autologous Platelet-Rich Plasma

BACKGROUND Paronychia has been reported in as many as 10% of patients treated with gefitinib. Although conservative management and treatment with topical or systemic antibiotics are beneficial, no effective method exists for intractable cases. Platelet-rich plasma (PRP) consists of a high concentration of platelets that promote wound healing through chemotaxis, cell proliferation, angiogenesis, and tissue remodeling. OBSERVATIONS We herein report a refractory case of gefitinib-induced paronychia successfully treated with autologous PRP. A 68-year-old woman who had been diagnosed as having lung adenocarcinoma with multiple bone and brain metastases initiated gefitinib therapy at an oral dose of 250 mg/d. After 1 month, multiple paronychia with periungual granulation appeared on the nail fold of the first, second, and third toenails of both feet. Because the paronychia recurred repeatedly despite use of a topical antibiotic, topical corticosteroid, and short-term systemic antibiotic, she started PRP treatment. After 3 months, the lesion showed marked improvement with minimal pain or discharge. CONCLUSION This case highlights the therapeutic challenges of using PRP to promote tissue repair in intractable gefitinib-induced paronychia and merits further investigation.