Beau's Lines After Razoxane Therapy for Psoriasis

To the Editor.—  We were interested to read the April Archives case report by James and Odom¹ describing transverse white lines in the fingernails following chemotherapy and the subsequent short report in the July Archives by Wantzin and Thomsen² of pigmented nail bands, nail shedding, and acute paronychia following high-dose methotrexate therapy. Both sets of authors attributed the nail changes to an alteration of nail growth, and Wantzin and Thomsen postulated that this was the consequence of a direct cytotoxic action on the nail matrix and paronychium.We have long been surprised that Beau's lines and striate leukonychia, which probably both represent disturbances in nail growth of varying severity, are so seldom seen in patients undergoing systemic chemotherapy with methotrexate for psoriasis. A course of regular chemotherapy with razoxane (ICRF 159) ( ± )1,2-bis (3,5-dioxopiperazin-1-yl) propane was recently started for a 70-year-old man with severe psoriasis. This is a