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Silk et al. Hepatoma Res 2020;6:73 I http://dx.doi.org/10.20517/2394-5079.2020.61 Page 5 of 16

Figure 3. Subungual splinter hemorrhages in a patient on Sorafenib. Reprinted from Ishak et al. [33]

SCROTAL ECZEMA
Symptoms
[32]
Scrotal eczema appears as erythematous macules .

Treatment
Scrotal lesions seen with TKIs have been treated with athletic supporters to reduce friction and barrier
ointments/pastes such as zinc oxide and menthol. Topical steroids can also be used [15,32] .

SUBUNGUAL SPLINTER HEMORRHAGES
Symptoms
Subungual splinter hemorrhages appear as multiple subcentimeter longitudinal brown to black lines
[26]
beneath the distal nail plate. They are asymptomatic .

Treatment
Subungual splinter hemorrhages do not require treatment as they tend to spontaneously resolve [15,26,27]
[Figure 3].

ALOPECIA
Symptoms
Alopecia may occur with thinning or patchy hair loss. Complete alopecia has been seen in patients with
renal cell carcinoma treated with Sorafenib. Alopecia can involve loss of hair on the body as well as the
[26]
scalp .

Treatment
Alopecia produced by TKIs although distressing to patients has not been shown to require dose
[26]
modification. Alopecia has spontaneously resolved in some patients despite continued treatment .