Beau’s Lines: Another Cancer Side Effect They Don’t Tell You About


After chemo treatment, my nails were like tree trunks — showing ages and environmental stress with ridges.

cartoon drawing of blogger and non-hodgkin lymphoma survivor, john smelcer

There are some things doctors don’t always tell you about during your TEACH session, where oncologists or nurses teach you about the cancer treatment process, duration, intensity, outcomes and warn about common side effects like hair and weight loss. But there are some fairly common side effects that you may never have heard of like “Beau’s lines,” named after the French doctor who first described them in 1846. Just as a tree can reveal its age by counting its rings and can inform us about its growing conditions from year to year based on the distance between lines (very close space between lines indicates poor growing years, while a larger space indicates that the tree grew well that year),the body also record the stresscaused by cancer treatment. But the toll on the body is more outwardly visible on people.

Similar to tree rings, our fingernails and toenails record the harsh effects of chemo on the body. I learned that chemotherapy kills fast-growing cells. Cancer is fast-growing cells. Hair and nails are also fast-growing cells. In its weakened condition, the body expends little or no energy trying to grow nails. They don’t fall off, but they slow down or stop growing altogether. Each cycle of chemo takes its toll, leaving ridges, grooves or dents instead of lines to indicate the starts and stops.

John Smelcer’s “Beau’s Lines," January, 2023

John Smelcer’s “Beau’s Lines," January, 2023

Five cycles: five ridges. Six cycles: six ridges, and so on. By my fifth cycle, my Beau’s Lines where remarkably conspicuous, so much so that my oncologist, who is the head of Oncology and a professor, asked to take pictures of my fingernails to use in his teaching at the medical university. I was happy to oblige.

The good news is that there is no pain associated with the phenomena. However, the nails (fingers and toes) become brittle and weak. They crack or split easily. Fortunately, the condition is reversible. It took half a year for the old, affected nails to grow out, the ridges disappearing month-by-month and one-by-one like a slow countdown for a rocket launch: 5, 4, 3, 2, 1.

My fingernails were useless for most of that time. They broke on little things, like opening a soda or beer can, trying to untie knots, or peeling off stickers or labels. I was amazed at how often I needed to use fingernails but had to ask my wife or daughter for help. Today, I have one ridge remaining at the end of both thumbnails, and have no doubt that they will be gone in another month. To help regrow my damaged nails (and lost hair), I took daily biotin gummies. I don’t know if they worked, but my hair is back and my nails are healthy.

As a poet, I wrote poems throughout my cancer experience. I wrote every day. I wrote so many poems that they were eventually compiled into a book. “Running from the Reaper: Poems from an Impatient Cancer Survivor” is now available online. Funny, sad, satirical, genuine and uplifting, the book is a perfect gift for anyone who has been diagnosed with cancer, who cares for someone with cancer, or who loves someone with cancer. I even wrote a poem about my peculiar fingernails (and toenails):



You know how you can tell the age of a tree

by counting its rings? Each ring is a year.

From their spacing, you can tell some years were better than others.

Because of the chemo, my fingernails tell a similar story.

There are five ridges on each nail, which look like

a series of sand dunes or the way high tides are marked

by a waterline on the beach, full of flotsam and foam.

Some might even describe them as ribbed like a rubber.

Doctors call them “Beau’s Lines.”

Each ridge sheds light on the history between chemo cycles,

when the toxic chemo stopped the nails from growing for a while.

The dune closest to each fingertip was made after the first cycle,

five months ago. Five cycles; five ridges.

My wife, the archaeologist, says my teeth will also show evidence

of the toll the chemo took on my body.

On the list of possible side effects the nurse warned us about

no one ever mentioned sand dune fingernails.

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