Isla Bennett
A dark line under the fingernail is known as melanonychia and can be caused by a number of factors, including trauma, medication, and underlying health conditions. Melanonychia is characterised by black or brown lines running vertically along the nail bed and can affect one or multiple nails. It is a result of increased deposits of melanin, which gives skin its colour. While melanonychia can occur naturally in people with darker skin tones, it is important to consult a doctor as it may be a sign of other health issues.
| Characteristics | Values |
|---|---|
| Name | Melanonychia, Splinter Hemorrhages, Beau Lines |
| Description | Dark lines on the nail |
| Colour | Black, Brown, Deep Red |
| Appearance | Vertical or Horizontal lines, Bands, Complete Darkening of the Nail Plate |
| Causes | Trauma, Pigmentation Changes, Nail Injury, Certain Medications, Underlying Health Conditions, Melanoma, Vitamin Deficiency, Iron Excess, Nail Infection, Fungal Infection, Cancer |
| Diagnosis | Dermatoscopic Exam, Medical History Review, Physical Exam, Biopsy |
| Treatment | Tumour Removal, Skin Graft, Antibiotics, Surgery |
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What You'll Learn
Melanonychia
- Longitudinal melanonychia or melanonychia striata. This type of linear melanonychia appears as brown, black, or grey bands that run from your nail bed to the tip of your nail.
- Diffuse or total melanonychia. This involves your entire nail turning dark.
- Transverse melanonychia. This type of melanonychia appears as a band that runs across your nail from one side to the other.
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Nail trauma
A dark line under the fingernail can be a symptom of nail trauma, which is a common injury that can occur in several ways. A blow to the nail, closing a finger in a door or drawer, or even something as minor as nail biting or cuticle biting can cause nail trauma. In addition, wearing ill-fitting shoes can lead to toenail trauma and subsequent deformities.
In some cases, the nail may need to be removed, and the nail bed may require repair. If the injury involves the nail matrix, which is the tissue inside the cuticle where new nail growth originates, a ridge or split can develop. Fortunately, if the matrix heals normally, the deformity will eventually disappear as the nail regrows. Fingernails typically regrow within about two months, while toenails can take up to four months.
It is important to note that any bleeding under the nail that is not caused by trauma should be evaluated by a doctor, as it could indicate an underlying condition. Additionally, if blood covers more than half of the nail area, it may signify a bone fracture or tissue tear, warranting medical attention.
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Vitamin deficiencies
Having a dark line on your fingernail is called melanonychia. It can appear in one or several nails and is usually a brown or black stripe that begins at the bottom of the nail bed and continues to the top. Melanonychia is caused by an increase in deposits of melanin, which gives skin its colour. Melanin deposits are caused by two primary processes, which have different causes.
One cause of melanonychia is melanocytic activation, which is an increase in the production and deposits of melanin in the nail but not an increase in pigment cells. Causes of melanocytic activation include trauma, nutritional deficiency, and medication. Nutritional deficiencies that can cause melanonychia include a lack of vitamin B12, vitamin D, vitamin B9 (folate), and protein.
The other cause of melanonychia is melanocytic hyperplasia, which is an increase in pigment cells in the nail bed. This growth can be benign or malignant. Melanocytic hyperplasia can be caused by a serious disease or by trauma, such as hitting your nail with a hammer, which can cause blood to pool under it and "turn on" the melanocytes in the nail bed. When this happens, melanin will collect in the nail cells and cause blackish or grayish discoloration.
If you notice a dark line on your fingernail, it is recommended that you have a doctor examine it, as it may be a sign of other health issues. A doctor may perform a dermatoscopic exam using a specific type of microscope to closely examine the discoloured areas and look for signs that the melanonychia may be malignant.
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Melanoma
Melanonychia, or a dark line under the fingernail, can be indicative of melanoma. Melanoma is a cancer of the skin that begins in the melanocytes, the cells responsible for skin pigment. Melanoma of the nail unit often starts as a narrow pigmented band visible on a single nail plate. It can be difficult to detect and treat early as the early signs are not always noticeable.
Nail melanoma is a rare form of skin cancer that can develop under and around the fingernails and toenails. It is the deadliest form of skin cancer. The most common signs of melanoma under the nails are dark streaks or bands on the nail, which can be brown or black. This can appear on any nail but most often affects the thumbnail or big toe. The dark band can be wide and irregular or narrow and dark. The pigmentation may also extend to the area where the fingernail meets the cuticle, known as Hutchinson's sign, which is often an indicator of melanoma.
If you notice any changes to your nails, including a new dark band, it is important to see a doctor or a dermatologist. They will conduct a physical assessment of the fingernail and may ask about your medical history. If they suspect melanoma, they will biopsy the nail matrix and nail bed to determine if the cells are cancerous. If melanoma is diagnosed, further tests will be ordered to determine the spread of the cancer. Treatment may involve surgically removing the affected area, which can include removing the entire nail or a portion of the digit.
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Fungal infections
A dark line under the fingernail can be indicative of a fungal nail infection, also known as onychomycosis or tinea unguium. This occurs when a fungus that is normally present in the fingernails or toenails overgrows.
There are four main types of fungal nail infection, each with distinct characteristics:
- Distal or lateral subungual onychomycosis: This is the most prevalent variety, typically affecting the nail bed beneath the nail. It is caused by a fungus called a dermatophyte and can manifest in both fingernails and toenails. It begins as a yellowish area that spreads from the edges of the nail towards the centre, eventually causing the nail to detach from the nail bed.
- White superficial onychomycosis: This type is less common and primarily affects the nail surface, particularly the toenails. It starts as white spots that transform into a powdery substance, ultimately leading to nail crumbling.
- Proximal subungual onychomycosis: This rare form of infection usually affects individuals with compromised immune systems, such as those with HIV infection. It initially presents as white spots in the centre of the nail bed near the cuticle and gradually moves outward as the nail grows.
- Edonyx onychomycosis: In this type of onychomycosis, the interior of the nail plate is infected, but the nail bed, which is the tissue underneath the hard part of the nail, remains unaffected.
Fungal nail infections can be challenging to treat, and topical medications applied directly to the nail are often ineffective. Oral antifungal medications, such as Griseofulvin (Fulvicin®), Terbinafine (Lamisil®), and Itraconazole (Sporanox®), are more likely to be successful. Treatment duration typically ranges from six to twelve weeks, depending on the location of the infection.
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Frequently asked questions
A dark line under your fingernail can be caused by many conditions, including melanonychia, splinter hemorrhage, nail trauma, vitamin deficiencies, and nail melanoma. It is important to consult a doctor to determine the underlying cause and receive a proper diagnosis.
Melanonychia is characterized by black or brown discoloration of the nail plate, which can appear as a stripe or band on the nail. It occurs when there is an increase in melanin production and deposits in the nail. Melanonychia may appear in one or several nails and can occur naturally in people with darker skin tones.
A splinter hemorrhage is caused by trauma or injury to the nail, resulting in broken blood vessels beneath the nail bed. It typically appears as a thin, dark line running vertically along the nail. Other symptoms may include pain, swelling, and nail changes such as splitting or lifting away from the nail bed. Splinter hemorrhages usually heal within a few days, but if they occur across multiple nails, it could indicate an underlying condition.
