Discolored Nails – Causes of Spots, Lines, Streaks Color Changes

Refer to the article on Fingernail Ridges for more information and pictures on :

  • Healthy Fingernails
  • Normal Lines and Ridges on the Fingernails
  • Inflamed or Swollen Nail Fold
  • Ridges and Furrows (Grooves) on the Nails
  • Curved and Pitting Nails
  • Digital Clubbing (clubbing of the fingers)

Discolored Nails

It is important to differentiate pathology within the nail bed from that of the nail plate itself.

  • Red to dark brown streaks
    • Red to dark brown longitudinal lines or specks on the nail plate may be splinter hemorrhages. Causes include :
      • Trauma
      • Infective endocarditis
      • Psoriasis
      • Systemic lupus erythematosus (SLE)
      • Renal failure.
    • Brown longitudinal streaks may be due to :
      • Melanocytic nevus
      • Malignant melanoma
      • Addison’s disease
      • Racial variants may also be a cause.

  • Red to dark brown spots or patches
    • Subungal hematomas (bleeding under the nail) may initially appear as a red to maroon or dark brown spot or patch. Usually this occurs as a result of an injury. Over time, this spot or patch to a purple or brown-gray color.
  • Yellow to brown nails
    • Dermatophyte infection (nail fungus – onychomycosis) – most commonly affects the toenail and causes crumbling of the nails.
    • Psoriasis
    • Jaundice
    • Heat damage
    • Addison’s disease
    • Amyloidosis
    • Drugs like tetracycline, chlorpromazine, gold salts (for rheumatoid arthritis)
    • ‘Nicotine stains’ from cigarette smoking
  • Yellow nail syndrome is a rare disorder where there is defective lymph drainage leading to lymphedema and pleural effusions or other respiratory disorders like bronchiectasis. It may be due to genetic causes.
  • Brown to gray nails
    • Vitamin B12 deficiency
    • Diabetes mellitus
    • Cardiovascular disease
    • Breast cancer
    • Malignant melanoma
    • Lichen planus
    • Syphilis
    • Exposure to hair dyes, solvents like acetone for removing false (acryclic) nails, nail varnish
  • White nails
    • Whitish discoloration may be due to :
      • Anemia
      • Renal (kidney) failure
      • Cirrhosis (liver) as a result of hypoalbuminemia (rare)
      • Diabetes mellitus
      • Chemotherapy
    • Rough, white nail (trachyonychia) may be due to lichen planus or severe alopecia areata.
    • Half white, half brown or red brown may be due to renal failure or liver disease (Terry’s half and half nails).
  • White spots
    • Trauma
    • Leukonychia stria (due to airspaces, not due to calcium deficiency)
  • Shiny nails
  • Shiny nails may occur in itchy skin conditions like eczema due to constant scratching and rubbing (buffing) elsewhere on the body. This does not involve the nails itself. Other causes includes excessive buffing for cosmetic purposes.
  • Blue nails
    • Cyanosis
    • Antimalarial drugs
    • Subungal hematoma
  • Bluish-green to black nails
    • Trauma (subungal hematoma)
    • Pseudomonas infection (chronic)
    • Exposure to chlorophyll derivatives, methyl green or silver nitrate and other chemicals

Related Articles

  1. Fingernail Ridges, Pits, Curved Nails – Health Problems, Pictures
  2. Parts of the Nail

References

  1. Examining the Fingernails. Emedicine