Doxycycline-Induced Photo-Onycholysis

Didier Rabar, MD; Patrick Combemale, MD; François Peyron, MD, PhD

In This Article

Case Report

Because there is a widespread resistance to other drugs, doxycycline is often prescribed as chemoprophylaxis for malaria. Although this drug is commonly used for the treatment of acne vulgaris, no large studies have been conducted on the safety of doxycycline. However, several side effects, especially skin and nail disorders, are induced by this drug. In this article, we report a case of photo-onycholysis in a woman undergoing doxycycline prophylaxis for malaria.

A 19-year-old woman was given doxycycline (100 mg/d) for malaria prophylaxis before traveling to a rural area of Cambodia between July and December 2001. Six weeks after she returned and 2 weeks after she stopped taking the drug, the patient visited a doctor for pain in six toenails and her right-hand thumbnail. An examination showed a half-moon-shaped, whitish detachment with an external hollow (Figure 1).

Examination of this 19-year-old woman's left toes revealed half-moon-shaped, whitish detachments with external hollows--onycholysis.

The lunula was normal, and there was no alteration of the nail plate, no under-nail bleeding, no nail pigmentation, and no Raynaud's phenomenon.

The patient had no history of dermatologic diseases or allergy, and other aspects of the clinical examination were normal. No psoriatic lesions were observed, and the patient reported that she had not taken other drugs, had contact with fish, used nail varnish, or visited a manicurist. The mycological sample taken from the nails was sterile, and the blood count was normal. There was no biologic inflammatory syndrome, and level of serum ferritin was normal. The diagnosis was tetracycline-induced photo-onycholysis. Such nail changes appear in temporal correlation with drug intake, and the clinical description was typical of that reported in the medical literature, with the involvement of several nails. Total recovery took 3 months for the toes and 4 months for the thumb.