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Kinesiology tapes wrapping for paronychia induced by epidermal growth factor receptor inhibitors: A pilot study

Epidermal growth factor receptor inhibitors (EGFRIs) are increasingly used in various cancers treatment including advanced lung cancer, but their potentially debilitating skin side effects could lead to cessation of treatment. Paronychia is one of the most common skin toxicities induced by EGFRIs. Painful periungual inflammation could affect patients' daily activities and weaken drug compliance. Although various treatments have been proposed, some patients may fail all available therapies and suffer from continuous pain. We aim to develop an easily accessible, patient-controlled therapy that effectively mitigates pain by using a special material, kinesiology tape, to protect nail borders. The participants of this study are the patients who suffered from treatment-refractory EGFRIs-related paronychia. The following were excluded: younger than 20 years old, severe ingrown nails, concomitant cutaneous infection, severe nail destruction, or chronic paronychia with severe periungual fibrosis. The study was approved by Institutional Review Board and the informed consents were obtained from all participants. In total, four patients were included. The kinesiology tape was cut to 1 cm wide and 5 cm long. Chemical cauterization with silver nitrate was applied for protuberant granulation tissues. We then wrapped the tape around the nail edge and tucked the tape between the nail plate and lateral nail folds (Figure 1). The patients were educated to avoid unnecessary water exposure and to wipe the tape after taking shower. During this tape treatment, the patients kept the same medications for paronychia as before that failed to control their symptoms, including topical or oral antibiotics, topical or oral corticosteroids, topical beta-blockers, and non-steroidal anti-inflammatory drugs. The patients were followed up at week 2 and 3. The treatment effect was evaluated by Common Terminology Criteria for Adverse Events (CTCAE), a scoring system for paronychia related to oncologic treatments (SPOT), and pain Visual Analogue Scale (VAS) from 0 to 10, with 10 indicating the worst pain possible. The scores were compared using paired-sample t-tests using R version 4.0.2. On average, we observed total resolution of pain within 2.5 days and partial resolution of inflammation within 3 weeks. After treatment, the average toe-level SPOT scores decreased from 6 to 4 (P = 0.003), the average VAS decreased from 5 to 0 (P = 0.042), and the average CTCAE decreased from 2 to 1 (P = 0.182). Of the 4 patients, 3 had successfully replaced the tape when it fell off and prolonged the same pain-relieving effect. The tape stayed fixed for roughly 1 week with regular activities. This result suggested kinesiology tapes might provide additional therapeutic benefits in patients failing traditional treatments for months. The benefits might result from the protection of EGFRIinduced fragile skin, which was believed to be the pathogenesis of paronychia. Previously, kinesiology tape has been proposed for onychocryptosis. The kinesiology tape provides stronger in-place adherence and greater resistance to water splash than conventional packing materials, which do not adhere to the skin surface tightly and easily fall off after daily activities. Unlike traditional taping, this method does not require the tape to be stretched and fixed at a more proximal point, which limits joint movement and increases the likelihood of detachment. Therefore, the tape could adhere firmly to the nail border for a relatively long period. This greatly lessens the frequency of replacement and could increase the patient's adherence. This therapy could easily be continued by patients themselves at home because the materials are easily accessible and the patients were able to learn the correct tape replacement technique after the first demonstration. A side effect of this method is mild skin irritation after prolonged taping. Mild scaling and erythema without itching were observed in 2 patients after 3 weeks of continuous taping.