Isla Bennett
There are many reasons why fingernails may turn black. Black nails can be alarming, and while they are sometimes harmless, they can also indicate an underlying issue that requires medical attention. Melanonychia, a condition characterised by brown or black stripes on the nail, is a common cause of black nails. It can be caused by trauma, nutritional deficiencies, medication, or an increase in pigment cells in the nail bed, which can be benign or malignant. Other causes of black nails include fungal infections, bacterial infections, chemotherapy, and tight shoes. Identifying the underlying cause is crucial for proper treatment.
| Characteristics | Values |
|---|---|
| Condition | Melanonychia, also called melanonychia striata or longitudinal melanonychia |
| Description | Dark lines or stripes on the nail bed, usually brown or black |
| Causes | Trauma, injury, fungal infection, bacterial infection, viral infection, inflammation, chemotherapy, certain medications, nutritional deficiency, cancer, melanoma, endocrine disorders, racial differences, pregnancy, etc. |
| Diagnosis | Dermatoscopic exam, biopsy, medical history review, and other tests |
| Treatment | Surgery, antifungal medication, avoiding nail-biting, wearing loose shoes, etc. |
| Prevention | Proper nail care, keeping nails clean and dry, avoiding harsh chemicals, regular moisturizing, etc. |
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What You'll Learn
Trauma to the nail
In the case of trauma, the discolouration is related to the rupture of small blood vessels, causing blood to become trapped under the nail. Bruising typically forms shortly after the injury, and other symptoms may include pain or swelling in the finger.
If the black nail persists or is accompanied by pain, swelling, or other concerning symptoms, it is advisable to seek medical attention. A doctor can perform a dermatoscopic exam using a specific type of microscope to closely examine the discoloured areas. They will typically look for signs that the discolouration may be malignant.
In some cases, the cause of black nails may be related to underlying health conditions, such as nail cancer, or melanoma of the nail bed, which is the most serious possible cause of melanonychia. Melanonychia is the appearance of brown or black stripes on the nail and can be caused by an increase in the production and deposits of melanin in the nail. This can occur due to trauma, nutritional deficiencies, or medication.
It is important to note that not all black nails are a cause for concern, and identifying the underlying cause is essential for proper treatment and management.
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Underlying health conditions
Fingernails turning black can be indicative of underlying health conditions. One such condition is melanoma, the most serious type of skin cancer. Melanoma on the nail is characterised by the appearance of a dark brown or black spot, which is most common on the index finger, thumb, or big toe. The discolouration tends to increase in size over time. Melanonychia, a condition characterised by brown or black stripes on the nail, can be caused by several factors, including trauma, nutritional deficiency, medication, and infection. It can also be associated with inflammatory skin diseases, such as Addison's disease and Cushing's syndrome, and is more prevalent in people with dark skin complexions.
Melanonychia can be caused by two primary processes: melanocytic activation and melanocytic hyperplasia. Melanocytic activation occurs when melanocytes, the pigment cells in the nails, are activated to produce melanin, resulting in brown or black stripes. This can be triggered by various factors, including trauma, nutritional deficiencies, and medication. Melanocytic hyperplasia, on the other hand, refers to an increased number of melanocytes in the nail bed, which can be benign or malignant. It is important to consult a doctor if you notice any discolouration or stripes on your nails, as they can help diagnose and treat any underlying health conditions.
Nail discolouration can also be caused by fungal infections, which can turn the nails black. This occurs when fungi invade the nail bed and can be a result of poor hygiene practices, such as not regularly cleaning and trimming the nails, or excessive moisture from sweaty feet or tight-fitting shoes. Certain medications, such as chemotherapy drugs, antibiotics, and heart medications, have also been known to cause nail discolouration as a side effect. In some cases, black nails can be caused by minor injuries or activities that put pressure on the nails, such as running or wearing tight shoes. However, if the discolouration persists or is accompanied by pain, swelling, or other symptoms, it is advisable to seek medical attention.
Additionally, some systemic diseases, such as Addison's disease and Cushing's syndrome, can cause melanonychia in several fingernails or toenails. This usually presents as diffuse melanonychia or multiple streaks. Certain drugs can also cause transverse melanonychia in multiple nails. People receiving chemotherapy or who have undergone X-rays may also experience melanonychia. Melanonychia can also be associated with inflammatory skin diseases, bacterial infections, and fungal infections.
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Medication side effects
Melanocytic activation can be caused by medication, trauma, nutritional deficiency, or other factors. Drugs that can cause melanonychia include zidovudine, psoralens (PUVA), hydroxyurea, and other chemotherapy drugs. Antimalarial drugs such as hydroxychloroquine and chloroquine can also cause brownish discolouration of the nail bed.
Other medication side effects that can affect the nails include Beau's lines, which are grooved horizontal depressions in the nail surface caused by a decrease in keratinocyte cell division in the proximal nail fold. Beau's lines are commonly seen with chemotherapy and radiation treatment. Onychomadesis, or nail shedding or splitting, is an extreme form of Beau's lines. Leukonychia, or milk spots, occurs when drugs affect keratinization.
Drug-induced photoonycholysis is a rare allergic or toxic reaction to ultraviolet radiation that separates the nail plate from the nail bed. It is often painful and can be prevented by avoiding sun exposure and applying opaque nail polish.
Additionally, drugs can alter nail vessels, causing haemorrhage or ischemic changes. Ischemic changes can range from mild to severe, including digital gangrene in patients with severe peripheral vascular disease. These changes may be reversible.
It is important to consult a healthcare professional if you experience any nail-related side effects from medication. They can recommend treatments or management tips and determine if any further action is necessary.
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Melanin deposits
Melanocytic Activation
This type of melanonychia occurs when melanocytes, or pigment cells, are activated to produce melanin. The number of melanocytes remains the same. Causes of melanocytic activation include trauma, nutritional deficiencies, and medication. Trauma can include injuries such as stubbing your toe or finger, dropping heavy objects on them, or repetitive activities that put pressure on the nails. Nutritional deficiencies that can cause melanonychia include a lack of protein, vitamin D, or vitamin B12. Certain medications that may cause melanonychia include chemotherapy drugs, antibiotics, and medications used to treat specific heart conditions.
Melanocytic Hyperplasia/Proliferation
This type of melanonychia is a result of an increased number of melanocyte cells in the nails. The growth of melanocyte cells can be benign or malignant. Melanocytic hyperplasia/proliferation can be caused by inflammatory skin diseases that affect the nails, friction from shoes, biting your nails, and poor nutrition. It can also be caused by fungal, bacterial, and viral infections.
It is important to note that melanonychia is more prevalent in people with dark skin complexions. It is also more common in people of colour and in certain racial groups, including African Americans, Hispanics, Indians, and Japanese people. If you notice any discolouration of your nails, it is recommended to consult a healthcare professional for a proper diagnosis and treatment.
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Bacterial infections
Fingernails turning black can be caused by various factors, including bacterial infections. While bacterial infections are not as common as fungal infections, they can occur in people with weakened immune systems. For example, people whose work involves prolonged or repeated contact with water or wet substances are more likely to develop bacterial melanonychia.
People with a weakened immune system are at a higher risk of developing bacterial infections that can lead to melanonychia. Certain bacteria, such as Pseudomonas, can cause this condition. Environments that expose individuals to bacteria, such as through frequent contact with water, can also increase the risk of bacterial melanonychia.
It is important to consult a dermatologist or healthcare provider if you notice black nails, especially if the condition worsens or persists. Treatment options for bacterial melanonychia may include taking antibiotic medications. In some cases, surgery may be required if the infection has caused structural damage to the nail or underlying tissue.
While less common, bacterial infections can cause black nails in individuals with weakened immune systems or those frequently exposed to bacteria. Consulting a healthcare professional is essential to receiving an accurate diagnosis and appropriate treatment.
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Frequently asked questions
There are several reasons why fingernails may turn black. This includes fungal infections, certain medications, underlying health conditions, and trauma or injury to the nail bed.
Black fingernails can be a sign of several medical conditions, including melanoma, malnutrition, and certain infections. It is important to consult a doctor or dermatologist if you notice any discoloration or other concerning symptoms.
Yes, several risk factors have been identified for developing black fingernails. These include wearing tight shoes or gloves, poor hygiene practices, excessive moisture, and specific medications such as chemotherapy drugs and antibiotics. Individuals with dark skin complexions are also more likely to experience black fingernails.
