Sophia Delgado
There are many reasons why someone's fingernails might turn black. It could be caused by something as simple as a direct blow to the finger, or it could be a sign of something more serious, such as melanoma or nail cancer. Melanonychia, which is the appearance of black or brown lines on the fingernail, can be caused by trauma, nutritional deficiencies, or medication. In some cases, it can also be a sign of an underlying health condition. It is important to consult a doctor or dermatologist if you notice any changes in the color of your fingernails, as it could indicate a more serious issue.
| Characteristics | Values |
|---|---|
| Cause | Direct blows to the fingers, habits like biting or pulling out nails, wearing tight shoes or gloves, antifungal or chemotherapy medications, nail injury, infection, cancer, nutritional deficiency, medication, trauma, psoriasis, physiological processes (pregnancy), bacterial infection, blood under the fingernail, and more |
| Symptoms | Pain, swelling, nail deformities, throbbing pain, bruising, black spots or lines under the nail, darkening of the nail, dark brown or black spots, thick, overgrown nails, pitted nails, spoon-shaped nails, washboard nails, clubbing, etc. |
| Treatment | Avoiding habits like biting nails, wearing looser shoes and gloves, antifungal medications, surgery, targeted treatment, ice, anti-inflammatory medication, drainage of trapped blood, and more |
| Diagnosis | A dermatologist can help identify the cause and start treatment. A biopsy may be ordered to confirm the diagnosis. |
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What You'll Learn
- Trauma to the nail, such as a blow to the finger, can cause a subungual hematoma, turning the nail black
- Melanonychia, a condition caused by increased melanin deposits, can result in black or brown stripes on the nail
- Bacterial infections, such as paronychia, can cause the nail to turn greenish-black
- Certain medications, including antimalarials and chemotherapeutics, can induce black nail discoloration
- Vitamin and nutritional deficiencies, such as low vitamin B12 or folate, can lead to dark lines on the nail
Trauma to the nail, such as a blow to the finger, can cause a subungual hematoma, turning the nail black
In most cases, applying ice and taking anti-inflammatory medication are sufficient treatments for a subungual hematoma. However, if the pain is particularly severe, a doctor may recommend draining the blood from under the nail to relieve the pressure and reduce symptoms. This procedure involves numbing the finger with a local anaesthetic before using a cautery, needle, or sterilised paperclip to drill or burn a hole in the nail. Typically, no follow-up treatment is required after this procedure, but occasionally, the whole nail may need to be removed.
Subungual hematomas can also be caused by habits such as biting or picking at your nails, which can cause black spots or lines to appear under the nail. These spots or lines typically do not increase in size or cause other symptoms, and they do not require targeted treatment beyond avoiding these habits to prevent worsening.
Trauma to the nail can also cause splinter haemorrhages, which present as small black lines that form vertically underneath the nail. These are the result of damage to small blood vessels underneath the nail and can occur when something hurts the nail bed. Splinter haemorrhages can also be caused by endocarditis, a heart condition that results in an infection of the inner chambers or valves of the heart.
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Melanonychia, a condition caused by increased melanin deposits, can result in black or brown stripes on the nail
Melanonychia, characterised by black or brown stripes on the nail, is a condition caused by increased melanin deposits in the nail or changes in nail pigmentation. It is important to consult a doctor for a diagnosis of melanonychia, as it may indicate other health issues. Melanonychia can be caused by two types of melanocytic activation:
Melanocytic Activation
This process involves an increase in the production and deposits of melanin in the nail, without an increase in pigment cells. Causes include trauma, nutritional deficiencies (folate, vitamin B12, vitamin D, and protein), and medication.
Melanocytic Hyperplasia
This process involves an increase in pigment cells in the nail bed, which can be benign or malignant.
Melanonychia can develop due to various causes, including nail cancer, trauma, and other health conditions. It is important to note that melanonychia may appear naturally in individuals with a dark complexion.
If melanonychia is suspected, a healthcare professional will typically perform a series of examinations, including a dermatoscopic exam using a specific type of microscope to closely examine the discoloured areas. A nail biopsy may also be performed to confirm the diagnosis.
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Bacterial infections, such as paronychia, can cause the nail to turn greenish-black
Paronychia is a bacterial nail infection that can cause the nail to turn greenish-black. It occurs when bacteria enter broken skin near the cuticle and nail fold, causing an infection. The cuticle is the skin at the base of the nail, and the nail fold is where the skin and nail meet. Paronychia can affect both the fingernails and toenails.
Bacteria, such as Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas, are common causes of paronychia. These bacteria can enter the skin through cuts, broken skin, hangnails, or ingrown nails. Certain occupations that require frequent hand washing or exposure to water, such as bartenders and dishwashers, have a higher risk of developing paronychia. Additionally, jobs that involve working with chemicals, such as detergents, can also increase the risk of infection.
The symptoms of paronychia include pain, swelling, and tenderness around the nail. The skin may be red and warm to the touch, and pus may build up under the skin, forming a white to yellow, pus-filled abscess. If left untreated, the nail can become distorted, ridged, and discolored, appearing yellow, green, or black. The nail may also become brittle and detach from the nail bed, eventually falling off.
The treatment for paronychia involves the use of antibiotics to kill the infection. In some cases, drainage of pus or surgical removal of the nail may be necessary. Soaking the affected finger or toe in warm water several times a day can also help. It is important to seek medical attention if you suspect you have paronychia, as early treatment can prevent the infection from worsening and help alleviate pain and tenderness.
While paronychia is a common cause of black fingernails, there are other potential causes as well. For example, dark nails can also be caused by direct blows to the fingers, nail-biting, or picking at the nails. Certain medications, such as antifungal or chemotherapy drugs, can also cause dark spots or lines on the nails. Additionally, underlying conditions such as vitamin deficiencies, circulation problems, or more serious issues like melanoma, can contribute to dark nails. Therefore, it is always advisable to consult a dermatologist or medical professional to determine the underlying cause and receive appropriate treatment.
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Certain medications, including antimalarials and chemotherapeutics, can induce black nail discoloration
Fingernail discoloration can be harmless, but it can also be a sign of disease. It is important to consult a doctor or dermatologist if you notice any changes in your nails, especially if there is no obvious cause.
Certain medications can induce black nail discoloration. This is known as drug-induced nail disease, or melanonychia in the case of black or brown nail discoloration. Melanonychia occurs when the skin overproduces melanin or pigment-producing cells (melanocytes). Melanonychia can be caused by inflammatory skin diseases that affect your nails, inflammation due to friction from shoes, biting your nails, or malnutrition. It can also be caused by certain medications, including antimalarials, chemotherapeutics, and antifungals.
Antimalarial medications can cause melanonychia, which appears as black or brown lines on the nail. This is due to an increase in the production and deposition of melanin in the nail. Antimalarial drugs are not the only type of medication that can cause melanonychia; it is also a side effect of chemotherapeutic agents. Chemotherapy is the medicine most likely to cause melanonychia. This is because drugs can damage the nail matrix (the hidden part of the nail unit under the cuticle) and the nail bed (the skin beneath the nail plate).
In addition to antimalarials and chemotherapeutics, other medications that may cause melanonychia include medications used to treat HIV/AIDS, biologics for inflammatory conditions, seizure medications, and antifungals. It is important to note that drug-induced nail disease is more common in older persons and those exposed to multiple medications. The signs and symptoms of drug-induced nail disease depend on the specific drug and may affect a single nail or all the fingernails and sometimes the toenails.
If medication is the cause of melanonychia, a healthcare provider may consider adjusting or changing your prescription. However, you should never stop or alter your medications without medical guidance.
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Vitamin and nutritional deficiencies, such as low vitamin B12 or folate, can lead to dark lines on the nail
Vitamin and nutritional deficiencies can indeed cause dark lines on the nail. Vitamin B12 is essential for overall nail health, as it plays a crucial role in cell division and growth, including the cells responsible for nail development. Nails can act as a window to micronutrient deficiency, and vitamin B12 deficiency can be easily spotted on your nails. Vitamin B12 deficiency can cause bluish or blue-black pigmentation with dark longitudinal streaks, and longitudinal and reticulate darkened streaks. The nail pigmentation associated with vitamin B12 deficiency is more frequent in patients with dark skin.
The clinical manifestations of vitamin B12 deficiency are megaloblastic anaemia, glossitis, and neurological symptoms like sensory abnormalities, tremors, and psychiatric symptoms. Other less common features are cutaneous hyperpigmentation, aphthous stomatitis, cheilitis, vitiligo, sparse lusterless hypopigmented hairs, and nail discolouration. The mechanism of hyperpigmentation is proposed to be decreased glutathione levels resulting in disinhibition of tyrosinase, an enzyme of melanogenesis leading to increased melanin synthesis. Cutaneous manifestations can be reversed with B12 therapy.
Nails are made up of a protein called keratin, so including protein-rich foods like lean meats, poultry, fish, beans, lentils, and dairy products in your diet can help strengthen your nails and promote growth. In addition to protein-rich foods, it is important to include vitamin B12-rich foods in your diet for strong and healthy nails.
Folic acid or folate deficiency may also cause central lines (grooves) in the middle of the nail. Iron, folic acid, or protein deficiency may cause these central lines, also known as koilonychia (nails that look like a spoon).
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Frequently asked questions
It could be due to melanonychia, which is caused by an increase in the production and deposits of melanin in your nail. It can be benign or malignant and is more prevalent in people with dark skin.
Yes, it could be due to a fungal infection, bacterial infection, or melanoma on the nail. It is important to consult a dermatologist to determine the exact cause.
Yes, there are several other potential causes of melanonychia, including nutritional deficiencies (such as a lack of vitamin B12, vitamin D, or protein), certain medications, and chemotherapy.
Yes, this is likely due to a build-up of blood under the fingernail, also known as a subungual hematoma. It is usually treated with ice and anti-inflammatory medication, but if it is particularly painful or the bleeding covers more than 25% of the nail, you should seek medical attention.
Yes, black nails can also be a sign of nail melanoma, which is the most serious possible cause of melanonychia. If you notice any new or changing dark streaks on your nails, it is important to consult a dermatologist for a skin cancer check.
