
Our nails can tell us a lot about our health. Changes in nail colour, texture, and structure can indicate underlying health conditions. For example, thick toenails could be a sign of a fungal infection, while dents or pits in your nails could indicate a systemic disease. In some cases, nail changes can even signal skin cancer. Therefore, it's important to be vigilant about any alterations in our nails and seek medical advice if we notice anything unusual. This is especially true if you experience nail thickening, discolouration, or layering, as these symptoms may indicate a double nail growing underneath the surface.
| Characteristics | Values |
|---|---|
| Discoloration | Brown, Black, Yellow, White, or Green |
| Texture | Thick, pitted, spoon-shaped, or brittle |
| Growth | Slowed or stopped |
| Pain | Acute retronychia causes pain |
| Infection | Redness and swelling |
| Injury | Repetitive injury or trauma |
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What You'll Learn

Thick toenails
Left untreated, thick toenails caused by fungal infections can lead to pain and discomfort. It is important to seek prompt treatment to resolve this issue and prevent further complications. Treatment options for fungal infections include topical treatments, oral medications, and, in some cases, surgical removal. However, even with surgical removal, it may take up to 18 months for the toenails to return to their pre-fungal appearance.
In addition to fungal infections, thick toenails can also be caused by injuries to the nail bed. In some cases, thick nails can be filed thinner to improve their appearance and comfort. Additionally, certain diseases, such as psoriasis, ichthyosis, or circulation problems, can contribute to thickened toenails, also known as Ram's horn nails. Seeking medical treatment for nail injuries and underlying conditions can help improve nail growth and thickness.
It is important to note that changes in toenail thickness may be a symptom of an underlying condition or chronic illness. Thick toenails can cause discomfort, especially when wearing shoes or walking. If left untreated, fungal infections can worsen and lead to secondary infections. While not all cases of toenail fungus require treatment, it is crucial to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan.
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Toenail discolouration
Minor Injuries
Nail Fungus
Nail fungus, or onychomycosis, is one of the most common causes of toenail discolouration, affecting up to 14% of the adult population. It is caused by dermatophytes, mould, or yeast, which grow by feeding on the body's keratin. The discolouration usually starts under the tip of the nail and can spread if left untreated. While mild infections typically respond well to over-the-counter antifungal treatments or home remedies, severe infections may require oral medications. Toenail fungus is more common than fingernail fungus, and older adults, people with reduced blood circulation, and those with weakened immune systems are at higher risk.
Subungual Melanoma
Subungual melanoma is a severe form of skin cancer that can appear as a dark stripe running lengthwise down the toenail. This stripe may have uneven edges and be wider than other types of melanoma stripes. It is caused by an overproduction of melanin by cells in the nail bed. Subungual melanoma is rare, accounting for only 0.7% to 3.5% of all malignant melanomas worldwide. However, it can be fatal if left untreated. Therefore, it is essential to seek medical care if you notice any colour changes in your toenails.
Yellow Nail Syndrome
Yellow nail syndrome is a rare condition that causes toenails to turn yellow and may be accompanied by breathing problems and swelling in the legs. It typically affects older adults, and the exact cause is unknown, although it sometimes runs in families. While there is no specific treatment for yellow nail syndrome itself, doctors may recommend oral vitamin E or antifungals. In some cases, the condition resolves on its own.
Other Causes
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Fingernail lifting
Onycholysis can be caused by various factors, including trauma, manicure tools, and moisture. Certain medical conditions, such as fungal infections, allergic reactions, and psoriasis, can also cause onycholysis by changing the nail's shape or the contour of the soft tissue bed beneath it. In these cases, the nail cannot attach smoothly to the nail bed. Additionally, exposure to certain medications and subsequent sun exposure can cause the nail to lift away from its bed.
The clinical features of onycholysis include an irregular border between the pink portion of the nail and the white edge of the lifted detached nail. The detached nail is usually white and opaque compared to the transparent normal nail that appears pink. However, lateral/proximal onycholysis may present as a yellow-pink colour instead of white. The nail surface may appear normal or pitted, indented, or crumbly. Thickened skin may accumulate under the detached nail, and subungual haemorrhage can occur in acute-onset onycholysis. While onycholysis is usually painless, it may be painful if acute or inflammatory.
If you suspect onycholysis, it is important to consult a medical professional to determine the underlying cause and receive appropriate treatment. Depending on the cause, your healthcare provider may prescribe treatment for any skin conditions, medical problems, or exposures contributing to nail lifting. For example, bacterial or fungal infections may be treated with antibacterial or antifungal medications. If you suspect that an underlying medical condition or medication is causing the onycholysis, your healthcare provider can help identify and address the issue or determine if alternative medications are available.
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Nail matrix damage
The nail matrix is the area where your fingernails and toenails form. It is the "factory" where your body makes new nails. A healthy nail matrix is essential for healthy nails. The nail matrix has two parts: the germinal matrix and the sterile matrix. About 90% of nail growth comes from the germinal matrix, which gives a natural curvature to the nail. The remaining 10% of cells that make up your nails come from the sterile matrix, which is more important for keeping your nail attached to the underlying skin.
Injuries and certain health conditions can damage your nail matrix and interfere with nail growth. Trauma to the nail can cause the production of new nail cells to stop for up to three weeks. Nail growth may resume at a faster rate after about 100 days, but the nail may appear thicker than usual. If the injury occurs in the germinal matrix at the base of the nail, it is possible that the nail may never grow back. Severe trauma, such as crushing injuries or deep cuts, may result in long-term or permanent effects if the nail matrix is significantly damaged.
Minor damage to your nail matrix can temporarily change your nail's appearance. You might notice dents, horizontal ridges or lines, pain or soreness, splits or cracks, spots or streaks of colour, and texture changes such as thickening or crumbling. In the case of severe nail matrix damage, some or all of your nail may not grow back.
If you notice any changes to your nails, it is important to see a healthcare provider. They can determine the cause and recommend treatment if needed.
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Subungual melanoma
The most common sign of subungual melanoma is brown or black discoloration on the nail bed, which can present as a streak of pigment or irregular pigmentation. This discoloration can progress to thickening, splitting, or destruction of the nail, and may be accompanied by pain and inflammation. In some cases, a periungual pigmentation known as the Hutchinson sign may be present, which is considered a pathognomonic sign of subungual melanoma. Other possible signs and symptoms of subungual melanoma include nail lifting, redness and swelling around the nail, and pitted nails with dents that resemble ice pick marks.
If you notice any changes in the appearance or texture of your nails, such as colour changes or lines, it is important to seek medical care. Your doctor will perform a clinical examination of the affected area and review your medical history, including your family medical history. They may also recommend a dermatoscopy or a full-thickness biopsy to confirm the diagnosis of subungual melanoma.
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Frequently asked questions
If you have a double nail growing, you will likely experience pain and discomfort. You may also notice a change in colour and texture, with nails appearing thickened, discoloured, and brittle.
Double nails are often caused by fungal infections, which can cause nails to thicken and grow in layers. Other causes include trauma or injury to the nail bed, certain illnesses, and conditions such as psoriasis or lichen planus.
If you notice any changes in your nails, you should seek medical attention. A healthcare provider can determine whether it is a nail matrix problem or another issue and recommend appropriate treatment.









































