{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T11:56:24Z","timestamp":1762430184888},"reference-count":10,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2007,3,20]],"date-time":"2007-03-20T00:00:00Z","timestamp":1174348800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Skinmed"],"published-print":{"date-parts":[[2007,3]]},"abstract":"<jats:p>A 53\u2010year\u2010old black man was diagnosed with poorly differentiated adenocarcinoma of the lung and treated initially with 4 cycles of paclitaxel in combination with carboplatin and external\u2010beam radiation therapy with a good clinicoradiologic response. The patient tolerated the chemotherapy well and did not develop any skin or nail changes during that period of time. His lung cancer recurred 10 months later, when he was found to have bone metastases. Second\u2010line chemotherapy with pemetrexed 500 mg\/m<jats:sup>2<\/jats:sup> intravenously every 3 weeks was commenced. A week prior, the patient was started on folic acid 1 mg orally daily and given an injection of vitamin B<jats:sub>12<\/jats:sub> 1000 \u03bcg intramuscularly that was continued every 3 cycles thereafter. Dexamethasone 4 mg orally twice daily was given around the time of chemotherapy administration to prevent the dermatitis associated with the drug. The patient denied taking other drugs. Two months into his second\u2010line chemotherapy, he developed multiple, concomitant, transverse and longitudinal black lines in all of his fingernails and toenails. After an interval of 3 months, he presented a complex pattern of nail hyperpigmentation, from combined dense horizontal and longitudinal streaks in some nails to diffuse black discoloration in others (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#f1\">Figure<\/jats:ext-link>). Other associated changes included koilonychia, dystrophy, and friability of nail plates. Along with normal results of a hepatorenal panel and normal serum vitamin B<jats:sub>12<\/jats:sub> and folate levels, no metabolic or endocrinologic alterations were present to explain the nail pigmentation and dystrophic changes. Results of his mycologic examination and cultures came back negative. When questioned, he denied taking any other drugs including other alternative medicine approaches or vitamin supplements, particularly retinoids, well known for causing severe nail dystrophy.<\/jats:p><jats:p><jats:fig><jats:caption><jats:p> <jats:italic>Most fingernails show a complex pattern of nail hyperpigmentation, comprising dense horizontal and longitudinal streaks, with some nails presenting a diffuse black discoloration. Associated koilonychia, dystrophy, and nail friability were present. (Inset) Nail enlargement detailing the pattern of discoloration and dystrophic changes.<\/jats:italic> <\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:15409740:media:SKM5720:SKM_5720_f1\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>","DOI":"10.1111\/j.1540-9740.2007.05720.x","type":"journal-article","created":{"date-parts":[[2007,3,20]],"date-time":"2007-03-20T15:17:01Z","timestamp":1174403821000},"page":"95-96","source":"Crossref","is-referenced-by-count":8,"title":["A Complex Pattern of Melanonychia and Onycholysis After Treatment With Pemetrexed for Lung Cancer"],"prefix":"10.1111","volume":"6","author":[{"given":"Constantin A","family":"Dasanu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter H","family":"Wiernik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Vaillant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doru T","family":"Alexandrescu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2007,3,20]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.3.1.57"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2002.120910"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-3083.2002.00424.x"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(20000515)88:10<2367::AID-CNCR22>3.0.CO;2-#"},{"key":"e_1_2_2_6_2","first-page":"13","article-title":"Biochemical pharmacology of pemetrexed","volume":"18","author":"Calvert AH","year":"2004","journal-title":"Oncology (Williston Park)"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.08.163"},{"key":"e_1_2_2_8_2","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1001\/archderm.1987.01660320030005","article-title":"Acute bullous dermatosis and onycholysis due to high\u2010dose methotrexate and leucovorin calcium","volume":"123","author":"Chang JC","year":"1987","journal-title":"Arch Dermatol"},{"key":"e_1_2_2_9_2","first-page":"68","article-title":"Unusual micromaculous melanoderma developing in patients with psoriatic erythroderma during methotrexate therapy","volume":"45","author":"Trofimova LI","year":"1971","journal-title":"Vestn Dermatol Venerol"},{"key":"e_1_2_2_10_2","first-page":"276","article-title":"Yellow nail pigmentation due to methotrexate","volume":"197","author":"Malka N","year":"1998","journal-title":"Dermatology"},{"key":"e_1_2_2_11_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1053\/sonc.2002.37461","article-title":"Molecular, biochemical, and cellular pharmacology of pemetrexed","volume":"29","author":"Goldman ID","year":"2002","journal-title":"Semin Oncol"}],"container-title":["SKINmed: Dermatology for the Clinician"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1540-9740.2007.05720.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1540-9740.2007.05720.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T19:29:57Z","timestamp":1696966197000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1540-9740.2007.05720.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,3]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2007,3]]}},"alternative-id":["10.1111\/j.1540-9740.2007.05720.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1540-9740.2007.05720.x","archive":["Portico"],"relation":{},"ISSN":["1540-9740","1751-7125"],"issn-type":[{"value":"1540-9740","type":"print"},{"value":"1751-7125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,3]]}}}