Noah Sinclair
Changes in the colour, texture, or shape of your nails can be harmless, but they can also indicate an underlying disease. One such change is the appearance of brown stripes on your nails, a condition known as melanonychia. Melanonychia occurs when pigment cells, called melanocytes, deposit melanin, a brown-coloured pigment, into the nail. While melanonychia can occur naturally in people with a dark complexion, it may also be caused by factors such as trauma, nutritional deficiencies, medication, or other health conditions. Given the potential health implications, it is important to consult a doctor or dermatologist if you notice any discolouration of your nails.
| Characteristics | Values |
|---|---|
| Name of condition | Melanonychia |
| Description | Dark lines on fingernails or toenails |
| Colour | Brown or black |
| Appearance | Stripes or bands |
| Occurrence | One or several nails |
| Cause | Melanin deposits, melanocytic activation, melanocytic hyperplasia |
| Risk factors | Dark complexion, trauma, nutritional deficiency, medication, chemotherapy, X-rays, endocrine disorders, fungal/bacterial/viral infections, inflammation, friction, nail biting, pregnancy |
| Diagnosis | Medical history, nail examination, dermatoscope, onychoscopy, biopsy |
| Treatment | Tumour/cancerous area removal, surgery, amputation |
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What You'll Learn
Melanonychia: a benign or malignant condition
Melanonychia is characterised by brown or black discoloration of the nail plate, with the pigment referred to as melanin. It may involve a single or multiple nails, both finger and toenails. The occurrence of melanonychia is more prevalent in people with dark skin complexions, with up to 77% to 100% of African Americans experiencing it, compared to only 1% of white people.
The condition can be caused by an increase in the production and deposits of melanin in the nail, known as melanocytic activation, or an increase in pigment cells in the nail bed, known as melanocytic hyperplasia. Melanocytic activation can be caused by trauma, nutritional deficiencies, or medication. Melanocytic hyperplasia can be benign or malignant and may be caused by nevi (moles) or lentigo (flat, pigmented areas of skin).
Melanonychia can also be associated with various types of fungal, bacterial, and viral infections, as well as inflammatory skin diseases that affect the nails. It is more common in individuals who work in environments with prolonged or repeated contact with water or wet substances, and those who participate in activities that cause friction or trauma to the nail plate.
While melanonychia can be benign and non-cancerous, it is important to note that it can also indicate a malignant condition, such as nail melanoma, which is the most serious form of skin cancer. Other malignant causes include nail unit melanoma (NUM) and melanomas in situ. Therefore, it is crucial to consult a doctor or dermatologist for a proper diagnosis if you notice any discoloration or other changes in your nails.
The diagnosis of melanonychia involves a series of examinations, including a medical history review, nail examination, and, in some cases, additional tests such as onychoscopy, which can help differentiate melanonychia from other conditions. Treatment options depend on the primary cause, and in the case of malignancy, surgery may be required to remove the affected nail unit or amputate the affected toe or finger.
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Potential nail melanoma
Melanonychia, or a dark line on your fingernails or toenails, can indicate potential nail melanoma. This is a rare but malignant form of skin cancer that can develop under and around the nails. It is often diagnosed at a more advanced stage than skin melanoma, making it more dangerous.
Nail melanoma usually presents as a brown or black band in the nail, often on the thumb or big toe, but it can appear on any nail. The band is typically wider than 3 mm, with irregular pigmentation and side borders. It may also cause nail plate dystrophy, or thinning, cracking, or distortion of the nail plate. In some cases, it can lead to nail splitting, pain, and inflammation.
If you notice any changes to your nails, such as a new dark band, it is important to see a board-certified dermatologist for a skin cancer check. They may examine your nails under a microscope, a process called onychoscopy, to help differentiate melanonychia from other conditions. While anyone can develop nail melanoma, it is more common in older individuals, people with skin of colour, and those with a personal or family history of melanoma or nail trauma.
The treatment for nail melanoma depends on the specific type and cause. In some cases, surgery may be recommended, which can involve removing the entire nail unit or amputating the affected toe or finger. Early detection is crucial, as melanoma under the nail, when found early, is highly treatable.
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Fungal, bacterial, or viral infections
Fingernails turning brown could be a sign of a fungal, bacterial, or viral infection. One such bacterial infection is paronychia, which occurs when bacteria get under the skin around the nail. Staphylococcus aureus bacteria cause staph infections, which are the most common cause of infectious paronychia. Other bacteria, such as Streptococcus pyogenes, can also cause the infection. Bacteria can enter the skin through cuts, broken skin, hangnails, ingrown nails, irritation from water or chemicals, or trauma to the nail bed or cuticle area. Nail biting, picking at cuticles, and frequent manicures or pedicures can create tiny cracks in the nails or cuts in the skin that allow bacteria to enter.
Additionally, a fungal infection called onychomycosis or tinea unguium can cause nail discolouration. This happens when a fungus that is normally present in the nails overgrows. Candida is a type of fungus that commonly causes toenail fungal infections and can also cause fingernail infections.
It is important to note that brown fingernails can also be a sign of melanonychia, which is a condition where pigment cells deposit melanin into the nail, causing brown or black stripes. This can occur naturally in people with a dark complexion or due to various causes such as trauma, nutritional deficiencies, medication, or other health conditions. A doctor should examine any discolouration to rule out more serious causes and determine the appropriate treatment.
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Trauma to the nail
Brown discolouration of the fingernails can sometimes occur due to trauma or injury to the nail. This can happen in several ways and is often the result of a direct impact or pressure on the nail. One common cause is a subungual haematoma, which is essentially a collection of blood under the nail. This can occur when the nail is crushed or hit with a force, causing bleeding under the nail bed. The blood may appear red at first, but as it breaks down, it can turn brown or black. This type of injury is often painful and may result in the nail becoming raised or detached from the nail bed. In such cases, it is important to seek medical attention to ensure proper treatment and prevent further complications.
Another form of nail trauma that can lead to brown discolouration is onycholysis, which is the detachment of the nail plate from the nail bed. This can occur due to a direct injury or constant pressure and friction on the nail. The nail may appear white or brown, and there is often a gap between the nail plate and the nail bed. Onycholysis can be painful and may make the nail more susceptible to infection. Treatment typically involves addressing the underlying cause and ensuring proper nail care to promote regrowth.
Fingernail injuries can also result in melanonychia, a condition where the nail produces more melanin, leading to brown or black streaks or pigmentation. This can occur due to repeated minor trauma, such as frequent tapping or pressing on the nail. The increased melanin production is the body's natural response to protect the nail bed from further injury. Melanonychia is generally harmless and may resolve on its own, but it is important to monitor for any changes or signs of infection.
In some cases, brown discolouration of the fingernails can be a result of nail psoriasis, a chronic inflammatory condition that can affect the nails as well as the skin. Nail trauma can trigger or exacerbate nail psoriasis, leading to pitting, ridging, thickening, or discolouration of the nails. The nails may also become loose and crumble easily. While nail psoriasis itself is not caused by trauma, any form of nail injury can trigger a flare-up and lead to these characteristic symptoms. Managing nail psoriasis typically involves treating the underlying condition and minimizing further nail trauma to prevent further flare-ups.
It is important to note that nail trauma can have varying effects and that the severity of the injury may determine the extent and duration of the discolouration. Minor injuries may only result in temporary discolouration, while more severe trauma can lead to long-lasting or permanent changes in nail appearance. Proper nail care and protection are crucial to prevent nail trauma and maintain healthy nails. This includes wearing protective gloves during activities that may subject the nails to impact or pressure, avoiding the use of nails as tools, and maintaining proper moisture and hydration of the nails and cuticles.
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Deficiencies in vitamins or minerals
Deficiencies in certain vitamins and minerals can cause nail discolouration and other nail abnormalities. One of the key indicators of nutrient deficiency is changes in nail health, and brown nails can be a sign of several vitamin or mineral deficiencies.
One of the most common deficiencies associated with nail changes is a lack of iron. Iron deficiency anaemia can cause a range of symptoms, including pale skin, fatigue, and brittle nails that may appear spoon-shaped (koilonychia). In some cases, iron-deficient nails may also turn brown. This discolouration is thought to be caused by oxygen deprivation in the nail bed, leading to a build-up of melanin, which gives the nail a brown or brownish-black appearance.
Deficiency in B vitamins, particularly biotin (B7), can also lead to nail abnormalities. Biotin plays a crucial role in supporting nail health and growth. A deficiency can result in brittle nails that may appear thin, concave, or split easily. While biotin deficiency typically causes nail thinning and breakage, it may also contribute to nail discolouration, including brown or yellowish nails.
A lack of zinc is another potential cause of nail changes. Zinc is essential for nail growth and strength, and a deficiency can lead to white spots or bands on the nails, known as leukonychia. In some cases, zinc deficiency may also cause nails to become brittle and discoloured, with a possible brown or brownish-red appearance. This discolouration is often accompanied by other nail changes, such as vertical ridges and increased fragility.
Additionally, a deficiency in essential fatty acids, particularly omega-3 fatty acids, may contribute to nail health issues. Fatty acids are necessary for maintaining the moisture and integrity of the nail bed. A deficiency can lead to dry, brittle nails that are more susceptible to breakage and splitting. While fatty acid deficiency typically causes nail dryness and brittleness, it may also potentially contribute to nail discolouration, including a dull, brownish appearance.
It is important to note that nail discolouration can have various causes, and self-diagnosis may be challenging. If you notice persistent or concerning nail changes, it is advisable to consult a healthcare professional or dermatologist for a proper evaluation and diagnosis. They may recommend dietary changes, supplements, or other treatments to address any deficiencies and improve nail health.
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Frequently asked questions
Brown nails can be caused by a few different factors, including fungal, bacterial, or viral infections, or even medication. If you notice any discolouration, it is important to get checked by a doctor as it could be a sign of a more serious health issue such as melanoma, the most serious form of skin cancer.
Brown nails are referred to as 'melanonychia', derived from the Greek 'melas' meaning black or brown, and 'onyx' meaning nail.
Melanonychia is characterised by brown or black stripes that begin at the bottom of the nail bed and continue to the top. It may appear in one nail or several and can be benign or malignant.
Melanonychia occurs when there is an increase in the production and deposits of melanin in the nail. Causes include trauma, nutritional deficiencies, medication, and infection.
If melanonychia is malignant, a doctor may suggest surgery to remove the nail unit or amputate the affected toe or finger. If benign, it may be left and monitored for any changes.
