Phytochemicals in African Plant Extracts Stop Chemotherapy Induced Nail Damage

Men and women receiving chemotherapy endure a host of troublesome side effects that affect their ability to perform simple activities of daily living. One, rather distressing, toxicity is nail damage (Onycholysis), which can affect up to half especially those receiving a commonly used category of drug called taxanes^1,2,3. Initially the nails feel hot, sensitive and painful, then ridges appear followed by splitting and separation of the nail from the nail bed. This breakdown of the normal anatomy leads to secondary fungal and bacterial infection that causes further misery and damage.

Current practices:

Supervising oncologists often reduce the dose of chemotherapy when nail damage gets too distressing but this may reduce the beneficial effects of chemotherapy. Oncology nurses advise anecdotal strategies including nail hygiene, wearing nail varnish and avoiding trauma with little or no evidence of success. Cooling the nails bed with iced water helps to reduce its severity⁴. Commercially available cooling gloves are available but they are not particularly popular among UK chemotherapy nurses as they cover the veins of the hands and prevent assessment of the patient's extremities^4,5,6.

Rationale for the UK Polybalm study:

A trial development committee was formed with phytochemists, herbalists, patients, oncologists and oncology nurses from Bedford and Addenbrooke’s Cambridge University Hospitals which worked in liaison with the National Cancer Research Institute’s lifestyle and behavioral change work stream. The bioactive pathways of a host of plant extracts were scrutinized from published laboratory and clinic data.  With an understanding of how chemotherapy damaged nails it soon became clear that a number of natural plant phytochemicals, particularly the polyphenolic acids and polyphenols have biological properties which could protect the nail bed from chemotherapy if applied locally ^{7,8,9,10,11,12}. The full evidence review for the specific essential oils and waxes chosen for this study and entire protocol itself can be found on the trials website (cancernet.co.uk/polybalm.com).  In summary these include:

• Anti-inflammatory

• Analgesic

• Anti-oxidant

• Enhance DNA repair

• Anti-bacterial and anti-fungal

• Moisturising and hydrating

 What is polybalm?

In contrast to the ingredients of conventional cosmetics, the UK manufacturers of polybalm only used unrefined oils, which were cold pressed or gradually warmed avoiding damage to their phytochemical content. The bases of extra virgin olive oil, organic beeswax, unrefined organic cocoa and shea butters. The essential oils included Gaultheria procumbens, lavandula officinalis, eucalyptus globulus, tarchonanthus camphoratus. They wanted to avoid any potential iritants so excluded any man made chemical such, preservatives, colours, parabens, sulphates or petroleum.

The UK Polybalm trial:

60 men and women receiving chemotherapy for breast or prostate cancer were randomised to apply either a simple petroleum moisturising balm to their nail bed 2-3 three times a day or the investigational balm now known as polybalm. None of the patients, doctors, research team or statistician knew which balm was assigned to which participant. The health of the nails was measured by 4 independent tools. Two completed by the patient concerning severity of symptoms and how they affected QOL and two by physicians assessing the physical disfigurement. 

Results:

There was a 180 fold difference in patient recorded QOL and an 11 fold difference in physician recorded disfigurement but both differences were highly statistically significant in all scores (unpaired T-test p<0.00001). There were no reported allergies or adverse events related to either creams. Only patients in the polybalm group had some nail changes also suffered from other severe chemotherapy complications including neutropenic sepsis, diarrhea and peripheral neuropathy¹³.

Conclusion:

The polyphenol rich essential oils and plant-based waxes in this nail bed balm profoundly reduced chemotherapy related nail damage and improved nail related quality of life compared to a plain petroleum based balm. The significant improvement in nail related quality of life will be welcomed by patients suffering this unwelcome toxicity which would otherwise significantly effect up to half of people receiving chemotherapy.

Footnote:

This study was audited to comply with good clinical practice guidelines and Cambridge University Central Research Ethics Committee approval. It was registered with the Health Research Authority. The balms were made specifically for this study by a UK registered manufacturer and European product cosmetic test were performed to fully comply with European Union Cosmetics Standards (ref: 76/768/EEC). No member of the research team received payments to recruit patients into the study. Although this was a scientific evaluation, the FDA and MHRA classed them as a cosmetic, so cannot be recommended for any medical condition or claim health benefits. The investigation balm should not be considered as an alternative medical treatment and should not be used against medical advice. The protocol was in the public domain and the balm, named after the clinical trial, is now distributed by an independent organization (polybalm.com) that has no connection to the trials unit.

References:

1. Minisini AM et al: Taxane-induced nail changes. Ann Oncol 14:333-337, 2003
2. Battegay EJ: Angiogenesis: Mechanistic insights. J Mol Med 73:333-346, 1995
3. Wasner G et al: Docetaxel-induced nail changes: J Neurooncol 58:167-174, 2002
4. Ding & Thomas: Cooling for chemo onycholysis. Clin Foc Can Med 2(1):18, 2010
5. Scottie: Frozen glove to prevent docetaxel onycholysis. JCO 23(19) 4424, 2005
6. Ishiguro: Freezing for docetaxel nail toxicity. Sup Care Can 20:2017-2024, 2012
7. Delaquis: Antimicrobial activity of plant oils. Int J Food Microbiol 74(1):101 2002
8. Smith-Palmer: Antimicrobial plant oils. Applied Microbiol 26(2):118-22, 2002
9. Baratta: Antimicrobial & antioxidant essential oils. Flav & Frag J 13(4):235, 2001
10. Radava. Herbs protect cells from UV radiation Pharmacogn Rev. 2011 5(10): 164
11. Mao-Qiang: Topical plant extracts & inflammation. Evid Based Com Alte Med. 2012
12. Baliga: Chemoprevention of botanicals. Phytochem Photobiol Sci. 2006, 5(2):243.
13. Thomas R et al. A double blind RCT of a polyphenolic rich plant balm for onycholysis – the UK Polybalm Trial. 2017 ASCO Proceedings Abstract:101003