ISSN: 2469-2778 HTIJ

Hematology & Transfusion International Journal
Case Report
Volume 3 Issue 3 - 2016
Melanonychia Blue Lunula: Result of Hydroxyurea Treatment
Ülkü Ergene and Can Özlü*
Department of Hematology, Bozyaka Education and Research Hospital, Turkey
Received: July 08, 2016 | Published: December 30, 2016
*Corresponding author: Can Özlü, Department of Hematology, Bozyaka Education and Research Hospital, İzmir, Turkey, Tel: +232-2505050; Email:
Citation: Ergene U, Özlü C (2016) Melanonychia Blue Lunula: Result of Hydroxyurea Treatment. Hematol Transfus Int J 3(3): 00069. DOI: 10.15406/htij.2016.03.00069


Hydroxycarbamide is used in the treatment of Essential Thrombocytosis (ET) and other myeloproliferative disorders [1]. Melanonychia is one of the cutaneous abnormalities including nail changes that could develop with long-term treatment with hydroxycarbamide [2]. Women have a tendency to melanonychia secondary to hydroxycarbamide usage [3]

Keywords: Hydroxy urea; Melanonychia; hydroxycarbamide; Essential Thrombocytosis

Case study

Case 1: 49-year-old male patient diagnosed JAK -2V617F positive Polycythemia Vera. After 11 months of treatment with 1000mg/day Hydroxyurea (HU), blue lunula and longitudinal melanonychia was seen in fingers and face (Figure 1).

Case 2: 63-year-old female patient diagnosed JAK-2V617F positive ET. After use of 1500 mg/day HU in 4 months; blue-black pigment changes in bilaterally fingernails-blue lunula transverse melanonychia occured. (Figure2). Patients were done to rule out other factors that cause melanonychia. After discontinued HU treatment, male patient’s melanonichia findings regressed within 3 months, for female patients it was 4 months. Melanonychia induced by drugs can be caused by the activation of nail matrix melanocytes. It can present longitudinal, transverse or diffuse pigmentation in the nail plate [4]. HU can rarely cause transverse and longitudinal melanonychia of both finger and toe nails. The occurrence of such a rare adverse effect with a common drug has prompted this report.

Figure 1: Melanonychia of the upper extremity hand-nails and face findings.
Figure 2: Blue lunula in nails and face findings.


  1. Boyd AS, Neldner KH (1991) Hydroxyurea therapy. J Am Acad Dermatol 25(3): 518-524.
  2. Vomvouras S, Pakula AS, Shaw JM (1991) Multiple pigmented nail bands during hydroxyurea therapy: an uncommon finding. J Am Acad Dermatol 24(6 Pt 1): 1016-1017.
  3. Neynaber S, Wolff H, Plewig G, Wienecke R (2004) Longitudinal melanonychia induced by hydroxyurea therapy. J Dtsch Dermatol Ges 2(7): 588-591.
  4. Piraccini BM, Iorizzo M (2007) Drug Reactions Affecting the Nait Unit: Diagnosis and Management. Dermatol Clin 25(2): 215-221.
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