Noah Sinclair
The appearance of coloured lines on the fingernail bed can be indicative of several health conditions. These lines can vary in colour, ranging from white, red, brown, or black, and can be associated with conditions such as leukonychia, erythronychia, melanonychia, splinter haemorrhages, or even cancer. While some causes are harmless, others may require medical attention and treatment. Therefore, it is important to seek professional advice if you notice any unusual coloured lines on your fingernail beds, as they can provide clues about your overall health and well-being.
| Characteristics | Values |
|---|---|
| White lines | Leukonychia striata, leukonychia |
| Brown-black lines | Longitudinal melanonychia |
| Red lines | Longitudinal erythronychia |
| Nail plate grooves | Beau lines |
| Horizontal white bands | Mees lines, arsenic poisoning |
| Reddish-brown lines | Splinter hemorrhages |
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What You'll Learn
- Melanonychia: Black or brown lines in your nail bed can be benign or malignant
- Leukonychia: White lines that can be caused by trauma, anemia, dietary deficiencies, or kidney disease
- Erythonychia: Red lines that can be caused by splinter hemorrhages
- Beau lines: Grooves in the nail plate
- Malignant melanonychia: Cancer of the nail that requires the removal of the tumour
Melanonychia: Black or brown lines in your nail bed can be benign or malignant
Melanonychia refers to black or brown lines that appear in your nail bed. It can be benign or malignant. Nails are usually translucent and non-pigmented. Melanonychia occurs when the pigment cells, called melanocytes, deposit melanin, a brown-coloured pigment, into the nail. This can lead to an increase in pigment cells in your nail bed, which is known as melanocytic hyperplasia. This growth can be benign or malignant.
Melanonychia can appear in fingernails or toenails and can occur in more than one nail. It may be longitudinal, running along the length of the nail, or it may be diffuse or transverse, running along the width of the nail. A dark vertical line on the nail can indicate nail melanoma, a type of skin cancer. Melanonychia can also be caused by trauma, infection, or other health conditions, such as deficiencies in vitamin B12, vitamin D, or protein.
If melanonychia is malignant or cancerous, the tumour or cancerous area must be removed, which may result in the loss of all or part of the nail, or even the finger or toe. A nail biopsy can cause structural irregularities due to the removal of a portion of the nail. A doctor can perform examinations to determine whether melanonychia is malignant.
It is challenging to detect cancer of the nail in its early stages due to its similarities to benign causes of melanonychia. However, research from 2017 suggests that a biopsy of most melanonychia is the best way to obtain an early diagnosis.
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Leukonychia: White lines that can be caused by trauma, anemia, dietary deficiencies, or kidney disease
White lines on the nail bed, also known as leukonychia, can be indicative of several conditions. Leukonychia is characterised by fingernails that are partially or completely white in colour. This abnormal whitening of the nails could be due to several factors, including trauma, anemia, dietary deficiencies, heart or kidney disease, or even poisoning.
Leukonychia can be categorised into two types: true leukonychia and apparent leukonychia. True leukonychia is caused by abnormal keratinisation of the underlying nail matrix, resulting in a white discolouration that persists even under pressure. On the other hand, apparent leukonychia is caused by abnormal nail bed vasculature, and the white discolouration disappears with pressure.
Transverse white nail lines, also known as Mees lines, are often associated with acute systemic stress, such as acute renal failure, heart failure, ulcerative colitis, breast cancer, and infections like measles and tuberculosis. Mees lines are also linked to exposure to toxic metals such as thallium. These white lines can be used to identify the timing of poisoning, as they tend to appear two months after the initial exposure.
Additionally, leukonychia can be a sign of systemic diseases, infections, drug side effects, or nutrient deficiencies. Specific nail findings within this category include Muehrcke lines, "half-and-half" nails, and Terry nails. Muehrcke lines are characterised by paired white transverse bands that span the width of the nail bed, running parallel to the distal lunula.
While leukonychia can indicate various potential health concerns, it is important to consult a medical professional for a proper diagnosis. A thorough examination of the fingernails and toenails, along with an understanding of nail anatomy, can help clinicians diagnose and treat nail disorders and identify any underlying systemic diseases.
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Erythonychia: Red lines that can be caused by splinter hemorrhages
Red lines in the fingernail bed are called longitudinal erythronychia. One cause of this condition is splinter hemorrhages, which are small areas of bleeding (hemorrhaging) under the nails. They can affect both the fingernails and toenails, but are more common in the former. Splinter hemorrhages get their name from their appearance, which resembles thin, red or reddish-brown wood splinters under the nail. They are usually 1 to 3 millimeters long and appear closer to the end of the nails, but any part of the nail may be affected.
Splinter hemorrhages occur when small blood vessels called capillaries under the skin beneath the nail bed burst due to damage. This can be caused by trauma or injury to the nail, which is the most common cause of the condition. They can also be caused by a rare benign (noncancerous) tumor of the nail called onychomatricoma, which can look similar to a type of skin cancer called subungual melanoma.
If an injury caused the splinter hemorrhage, it should go away on its own as the nail grows out. However, if you don't remember injuring yourself or if you have splinter hemorrhages affecting more than one nail, it is recommended to contact a healthcare provider. They will determine treatment based on the underlying cause of the condition and may request a test called a dermoscopy to help diagnose the condition. While most splinter hemorrhages don't require any treatment, keeping your nails strong and eating healthy foods rich in vitamin B and zinc can help reduce the risk of developing them.
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Beau lines: Grooves in the nail plate
Beau lines are horizontal depressions or grooves in the nail plate that may run parallel to the white, moon-shaped portion of the nail bed (lunula) seen at the base of the nail. They are caused by a sudden interruption in nail growth, often due to injury, illness, severe stress, or certain medications. Beau lines can occur on a single nail, which usually indicates trauma to that digit, or on multiple nails, suggesting a systemic cause or side effect of medication. These grooves can be indicative of serious conditions, such as acute kidney disease, and may even halt nail growth until the underlying issue is addressed.
Beau lines are typically 1-2 mm wide and can affect all fingernails. They are most commonly found in people who have recently recovered from a severe illness, such as the flu. In some cases, they may be caused by certain medications, with chemotherapy being the most common culprit according to a 2023 research review. Other causes of Beau lines include malnutrition, vitamin deficiencies, diabetes, and severe nail injuries.
While Beau lines themselves do not require self-care, addressing the underlying cause is crucial. Seeking medical advice is essential to determine the root cause and receive appropriate treatment. If the grooves are a cosmetic concern, they can be filled with gel nails and gently buffed.
The presence of Beau lines can be a valuable indicator of underlying health issues. A basic understanding of nail anatomy and the various types of nail lines enables clinicians to diagnose and treat nail disorders and recognize potential systemic diseases.
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Malignant melanonychia: Cancer of the nail that requires the removal of the tumour
Melanonychia is a black or brown discoloration of the nail, which can be longitudinal (running along the length of the nail), diffuse, or transverse (running along the width of the nail). It can occur in both finger and toenails and can appear in more than one nail.
Melanonychia occurs when the pigment cells, called melanocytes, deposit melanin, a brown-colored pigment, into the nail. Melanonychia can be caused by melanocytic activation or melanocytic hyperplasia. Melanocytic activation refers to an increase in the production and deposits of melanin in the nail, but not an increase in pigment cells. This can be caused by trauma, nutritional deficiency, or medication. Melanocytic hyperplasia, on the other hand, is an increase in pigment cells in the nail bed, and this growth can be benign or malignant.
Malignant melanonychia, or nail cancer, is challenging to detect in its early stages due to its similarities to benign causes of melanonychia. It often goes undetected as people are unaware of the warning signs. However, research from 2017 suggests that performing a biopsy on most melanonychia presentations is the best way to obtain an early diagnosis. A biopsy involves a healthcare provider extracting a small section of tissue from the affected area to test for cancer. A doctor may also perform a dermatoscopic exam using a specific type of microscope to closely examine the discolored areas and look for signs of malignancy.
If malignant melanonychia is detected, the tumor, and possibly all or part of the nail, must be removed. In some cases, this may even include amputation of the affected finger or toe. The standard treatment for subungual melanoma used to be amputation, but it is now considered a last resort. The most common treatment is surgery, and other cancer treatments may be recommended, such as immunotherapy or radiation therapy.
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Frequently asked questions
White lines in the fingernail bed, known as leukonychia, can be the result of several factors, including trauma, anemia, dietary deficiencies, heart or kidney disease, or poisoning.
Red or reddish-brown lines in the fingernail bed are called splinter hemorrhages, which are small areas of bleeding under your nails. They are typically caused by damage to the blood vessels under the nail bed and can occur due to injury or an underlying health condition.
Black or brown lines in the fingernail bed are referred to as melanonychia and are caused by increased deposits of melanin in the nail matrix. Melanonychia can be benign or malignant and may be a result of various factors such as trauma, infection, vitamin deficiencies, or even cancer.
