Clinical Tips: Nails and Cosmetic Injections

Tip 1: Managing Nail Changes of Cancer Therapies

Onycholysis, inflammatory paronychia, nail fragility, and onychoschizia are common adverse events associated with multiple cancer therapies, especially taxanes. To help manage these changes, patients can apply a combination of tazarotene around the nail fold nightly; clobetasol for perionychial erythema daily up to 3 weeks when needed; weekly white vinegar water soak for 5 minutes (to prevent infection, which is common); and a prescription nail protectant (the two I use, with no preference between the two, are polyureaurethane, 16%, and hydrosoluble nail lacquer).

Prevention is often the best medicine, so I try to have my patients apply a topical vasoconstrictor 30 minutes prior to infusion as well as use cooling gloves, though these are tough because you have to keep replacing the cool packs.

Dr Adam Friedman
Washington, DC

Tip 2: Skip the Pre-Cosmetic Cleaning

There is no evidence at all to support the use of any sort of wipes or scrubbing before botulinum toxin or fillers. The available evidence, mostly from the insulin literature, shows no benefit. Really, it is all theater, so do whatever you want or do nothing; it will not matter.

There was a study out of Sweden a number of years ago that showed that excessive scrubbing removed all the beneficial commensals and rendered the skin more susceptible to infection. We need an “anti-Semmelweis” to argue the case against excessive wiping and scrubbing!

Dr Kevin C. Smith
Niagara Falls, ON, Canada

Tip 3: Cosmetic Discounts

I automatically give discounts to patients when they do multiple syringes of filler or do lots of botulinum toxin. There are some people who are very price conscious or by their nature like to (almost need to!) negotiate, so for these people it is critical to tell them upfront that they are getting a substantial discount and the exact amount. I found I was giving them my automatic discount, and then when I told them the cost, they would say “can I get a discount” or “I’m doing so much stuff, can you reduce the cost,” and then it sounds after-the-fact odd when I say that I have already included the discount. n

Dr Benjamin Barankin
Toronto, ON, Canada