Greetings, Dr. Roach The splitting and peeling of my fingernails around the margins is a major issue for me. For nearly a year, I have tried keratin and biotin with little success. In addition to ibrutinib, Valtrex, allopurinol, cetirizine, and more lately, Eliquis and metoprolol succinate, I am an 89-year-old male. Is there a way out of this painful, awkward circumstance? — P.M.L.
ANSWER: Onychorrhexis is the splitting of the nails, whereas oncholysis is the separation of the nail from the nail bed. These issues can be caused by a surprisingly wide range of general and skin medical diseases. Nail issues can be brought on by working with damp hands all the time and by exposure to certain chemicals, such as polish remover, acrylic gels, and nail polish. Brittle nails can affect up to 20% of the elderly population. Oncholysis is caused by elevated thyroid hormone levels, which should be monitored, particularly in patients with Grave’s disease.
However, it is well recognized that ibrutinib, a tyrosine kinase inhibitor used to treat lymphomas and B-cell leukemias, causes this issue. In one study, ibrutinib-treated patients experienced 25% hair problems and 67% brittle nails.
Even while biotin only works for about 25% of people with this problem, it’s still an excellent option to try because it’s affordable and safe. It does affect hormone testing in the lab, particularly those for the thyroid hormone, giving the impression that something is wrong when it isn’t. (Before having your thyroid checked, you should stop taking biotin for two days.) If your oncologist is unable to recommend an alternative to ibrutinib, there are prescription nail lacquers that may be useful.
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Greetings, Dr. Roach You said in a recent essay that some common medications can make you gain weight. What kinds of medications are capable of doing this? — B.B.
ANSWER: Psychiatric meds are likely the most common class of drugs that might lead to weight gain. Weight gain is a common side effect of SSRIs and tricyclic antidepressants (amitriptyline, mirtazapine, and many more). Weight gain, often very significant weight gain, is a common side effect of antipsychotics, particularly clozapine but also many others. Additionally, several anti-seizure medications, such as gabapentin and carbamazepine, may.
Many diabetic medications, including insulin and those that raise the body’s production of insulin, such as glyburide, glipizide, and sitagliptin, can make some people gain weight. Weight gain is possible with oral contraceptives that contain progestins, such as minipills and any combination birth control pills.
Many prescribers undervalue the possibility that several blood pressure medications, particularly beta blockers (whose names all end in -olol), can induce weight gain. Weight gain is a common side effect of all corticosteroids, including hydrocortisone and prednisone, and HIV medications that belong to the protease inhibitor class.
Before trying to utilize additional medications to offset this adverse effect, it is typically possible to try alternatives to these medications.
Although he regrets not being able to respond to each letter individually, Dr. Roach will try to include them in the column. Questions can be sent by mail to 628 Virginia Dr., Orlando, FL 32803 or by email to [email protected].
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