Ava Monroe
A black line on your fingernail can be a cause for concern. While it could be something minor or normal, especially for those with darker skin tones, it could also indicate an injury, medication side effects, or an underlying health condition. Known as melanonychia or splinter hemorrhages, these black lines can appear as vertical or horizontal stripes and may require medical attention.
| Characteristics | Values |
|---|---|
| Medical term | Melanonychia or splinter hemorrhage |
| Description | Black or brown line running vertically along the nail bed |
| Causes | Melanocytic activation, melanocytic hyperplasia, trauma, nutritional deficiency, medication, infection, injury, health conditions, endocrine disorders, skin conditions, inflammation, chemotherapy, friction from shoes, nail biting, cancer |
| Treatment | Addressing the underlying cause |
| Action | Seek medical attention, especially if sudden changes occur |
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What You'll Learn
Melanonychia
Causes
- Melanocytic activation: This refers to an increase in the production and deposition of melanin into the nail cells (onychocytes) without an increase in the number of melanocytes. Causes include trauma, nutritional deficiency, and medication.
- Melanocytic hyperplasia: This refers to an increased number of melanocytes within the nail matrix. This growth can be benign or malignant. Causes include acute and chronic trauma from injuries or repeated friction, and infections.
Other causes of melanonychia include:
- Genetic disorders: It is more prevalent in people with skin of colour, especially Fitzpatrick skin type V and VI.
- Endocrine disease: This is usually present in multiple fingernails or toenails. It is associated with disorders such as Addison's disease, which is when the body doesn't produce enough of certain hormones.
- Inflammatory skin disease: This can be caused by inflammatory skin diseases that affect the nails, or inflammation due to friction from shoes and nail-biting.
- Poor nutrition: Malnutrition can cause melanonychia, especially a lack of protein, vitamin D, or vitamin B12.
- Tumours: Benign tumours and malignant tumours such as basal cell carcinoma can cause melanonychia.
- Pregnancy: Skin hyperpigmentation changes occur during pregnancy and can cause melanonychia.
- Medications: Chemotherapy is the medicine most likely to cause melanonychia. Other medications that may cause it include medicines used to treat HIV/AIDS and medicines used to prevent or treat malaria.
Diagnosis and Treatment
A diagnosis of melanonychia is reached after a series of exams. A healthcare professional may also review the patient's medical history for conditions that might cause melanonychia. They will likely examine the patient's fingernails and toenails using a dermatoscopic exam with a specific type of microscope to closely examine the discoloured areas. They typically look for signs that the melanonychia may be malignant. The doctor may also perform a biopsy of the nail.
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Splinter hemorrhages
A black line on the nail could be indicative of something minor or normal, but it is always recommended that you seek medical attention if you notice any changes in your nails, especially if there is no obvious cause. Nails can reveal important clues about your health and well-being, and a healthcare provider will be able to examine and advise on the next steps.
One possible cause of a black line on the nail is splinter hemorrhages. Splinter hemorrhages (or haemorrhages) are tiny blood clots that tend to run vertically under the nails. They are called splinter hemorrhages because they look like wood splinters under the nail. They are usually plum-coloured but can darken to brown or black in a few days. They can be single or multiple, and may be asymptomatic or tender. They can be the result of damage to small blood vessels underneath the nail.
There are many possible causes of splinter hemorrhages, including trauma, such as nail biting or using a cane, and applying acrylic nails. They can also be caused by a heart condition called endocarditis, which can cause clots to migrate from the affected heart valve and find their way into various parts of the body. If this happens in the finger, it can cause damage to the capillaries resulting in a splinter hemorrhage.
There is no specific treatment for splinter hemorrhages themselves. Any treatment is targeted at the underlying cause, which may be a systemic condition or a medication that needs to be discontinued. If caused by trauma, a splinter hemorrhage will usually grow out and disappear.
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Melanocytic activation
Melanonychia is a condition characterised by a brown or black stripe on the nail bed that continues to the top of the nail. It can affect one or multiple nails on the fingers and toes. The condition occurs due to increased melanin deposits in the nail or changes in the nail pigmentation. Melanonychia can be further categorised into two types: melanocytic activation and melanocytic hyperplasia. This answer will focus on the former.
- Trauma: Repeated, tiny traumas or a single large trauma can cause melanocytic activation.
- Nutritional deficiencies: Deficiencies in vitamin B12, vitamin D, and protein can lead to dark lines in the nails.
- Medication: Certain medications, particularly chemotherapy drugs, can induce melanocytic activation.
- Radiation exposure: Exposure to X-rays and electron beam therapy can trigger melanocytic activation.
- Infection: Bacterial, viral, and fungal infections can cause melanocytic activation.
- Inflammation: Inflammatory skin diseases, such as lichen planus or fixed drug eruption, can activate melanocytes and result in melanocytic activation.
- Pregnancy: Skin hyperpigmentation changes during pregnancy can lead to melanocytic activation.
- Race: Melanonychia can occur naturally in individuals with darker skin complexions, such as African Americans, Hispanics, Indians, and Japanese.
It is important to consult a healthcare professional if you notice any changes in your nails, especially if there is no obvious cause. A doctor can perform a physical examination, review your medical history, and conduct diagnostic tests to determine the underlying cause of melanocytic activation and rule out any serious health conditions.
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Melanocytic hyperplasia
The most common form of melanocytic hyperplasia is actinic melanocytic hyperplasia or actinic melanocytosis, which is caused by sun or UV light exposure. Chronic sun exposure has been found to lead to a twofold increase in melanocyte density. This is in contrast to melanoma in situ, which exhibits only focal confluence at the dermo-epidermal junction, limited pagetoid spread, and involvement of only the upper hair follicle.
The presence of melanocytic hyperplasia can be diagnosed by examining the nails and reviewing an individual's medical history. Doctors may also perform a dermatoscopic exam using a specific type of microscope to closely examine the discoloured areas. A nail biopsy may also be performed to confirm whether the melanonychia is malignant or benign.
While gradual changes in nail colour are often harmless, it is important to seek medical attention if you notice any sudden or unusual changes in your nails, as they can be indicative of underlying health conditions.
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Beau lines
- Trauma or damage to the nail matrix, such as dropping something heavy on your finger or toe, exposure to extreme cold, or slamming your finger in a door.
- Chronic conditions that interfere with blood flow to the nail matrix, such as hypothyroidism, peripheral artery disease (PAD), or Raynaud's phenomenon.
- Skin conditions, such as eczema or psoriasis.
- Severe emotional stress, such as a divorce, death in the family, or job loss.
- Nutritional deficiencies, such as a severe zinc deficiency or lack of protein in the diet.
- Environmental factors, such as exposure to extreme cold or certain chemicals.
- Certain medical treatments, such as chemotherapy.
If you notice Beau lines and are unsure of the cause, it is important to consult a healthcare provider to rule out any possible underlying health conditions. Treating the underlying cause will allow new, smooth nails to grow back in their place, which can take up to six months. In the meantime, you can temporarily hide the ridges by applying a nail ridge filler and nail polish. However, use nail products with caution, as some can weaken or damage your nails.
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Frequently asked questions
A black line on your fingernail could be the result of a number of things, from normal colour variation to injury, medication side effects, or health conditions. It is called melanonychia and can appear as a vertical or horizontal line.
Melanonychia is a brown or black streak of pigmentation that runs along the nail bed. It can affect one nail or several and can be harmless or a sign of a more serious health condition.
Melanonychia occurs when there is an increase in the production of melanin in the nail. Melanin is a brown-coloured pigment that gives skin its colour. Melanonychia can be caused by trauma, nutritional deficiency, medication, and skin conditions.
Treatment for melanonychia focuses on addressing the underlying cause. If it is caused by a health condition, managing that condition is the priority. If it is caused by medication, a healthcare provider may consider adjusting or changing your prescription.
If you notice a black line on your nail with no clear reason, it is important to have a doctor examine it. If the change happens suddenly, seek medical attention right away. It is also important to pay attention to any other new or unusual symptoms you may be experiencing.
