Sophia Delgado
Changes in the colour, texture, or shape of your nails can indicate an underlying health condition. One such condition is melanonychia, which causes brown or black lines in your nails. Melanonychia occurs when the pigment cells, called melanocytes, deposit melanin — the brown-coloured pigment — into the nail. While melanonychia can be benign, it can also be malignant in some cases. It is therefore important to see a doctor or dermatologist if you notice any changes in your nails.
| Characteristics | Values |
|---|---|
| Condition | Melanonychia |
| Description | Dark lines on nails |
| Causes | Melanin deposits, nail cancer, trauma, other health conditions, vitamin B12 deficiency, vitamin D deficiency, protein deficiency, iron overload, bacterial or fungal infection, skin colour, pregnancy, chemotherapy, X-rays, systemic diseases, drugs, nail matrix nevus, nail biting, anxiety, obsessive-compulsive disorder |
| Treatment | Tumour or cancerous area removal, dermatoscopic exam, nail biopsy |
| Prevention | N/A |
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What You'll Learn
Melanonychia
The causes of melanonychia range from benign to potentially fatal. It can be caused by melanocytic activation, which refers to an increase in melanin production from a normal number of activated melanocytes in the nail matrix. Alternatively, it can be caused by melanocytic proliferation, which refers to an increased number of melanocyte cells in the nails. This growth of melanocyte cells can be cancerous or noncancerous. Causes of melanocytic activation include race, trauma, infection, inflammation, and medications. Melanonychia can also be caused by nutritional deficiencies, such as a lack of protein, vitamin D, or vitamin B12. In some cases, it may be associated with pregnancy, with the discolouration clearing up after pregnancy or persisting.
It is important to see a doctor or dermatologist if you notice any dark streaks in your nails, as they can be indicative of nail cancer or melanoma, the most serious type of skin cancer. An early diagnosis of a malignant lesion is key to a favourable outcome. Doctors use the ABCDEF criteria to diagnose melanoma under the nail, considering factors such as age, race, and the presence of other risk factors. Treatment for melanonychia depends on the primary cause. If it is malignant, the tumour or cancerous area must be removed, which may result in the loss of all or part of the nail.
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Skin cancer
Dark nails can be a sign of subungual melanoma, a rare but serious form of skin cancer that appears under the nails. Also known as nail melanoma, this type of cancer usually manifests as a dark brown or black vertical streak on the nail, often on the thumb, index finger, or big toe. It is an aggressive form of melanoma that is not linked to sun exposure.
Subungual is a Latin word that means "beneath the nail or claw". This type of melanoma occurs when melanocytes, the cells responsible for skin pigment, are activated, leading to increased melanin production (hyperpigmentation). The vertical stripe that appears under the nail may start small but can grow to cover the entire nail and extend to the cuticle.
Nail melanoma is often discovered later than other cancers because people don't know the warning signs and may mistake it for a bruise or infection. It is important to regularly check your nails for any unusual changes, such as discolouration, nail lifting, nail splitting, or dark skin next to the nail. Early detection is crucial as it increases the chances of successful treatment and prevents the cancer from spreading throughout the body.
While anyone can develop melanoma on their nails, certain factors increase the risk. These include having darker skin, a personal or family history of melanoma, previous nail trauma, and being older than 50. Subungual melanoma is the most common type of melanoma among African American, Asian, and Hispanic people.
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Iron deficiency
Dark fingernails can be indicative of several conditions, one of which is iron deficiency.
Spoon nails are usually a sign of iron deficiency anemia, which occurs when a person does not have enough iron in their body to produce new red blood cells. Iron deficiency can be caused by several factors, including an inability to absorb iron, an inadequate intake of iron-rich foods, or excessive loss of iron due to conditions such as celiac disease, cancer, intestinal bleeding, or heavy menstrual bleeding.
While the exact mechanism is not fully understood, researchers believe that iron deficiency may lead to spoon nails due to reduced iron levels in the epithelial cells that cover the skin's surfaces, both inside and outside the body. Additionally, poor blood flow under the nail plate may contribute to the development of spoon nails.
If you suspect you have iron deficiency, it is important to consult a healthcare professional, who can provide guidance on dietary changes, supplements, or other treatments to address the underlying cause.
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Systemic diseases
Changes in the colour, size, shape, or texture of finger and toenails can be indicative of underlying systemic diseases. The nails are a key site of abnormalities in connective tissue diseases and vasculitis. The visual appearance of nails can provide clues to these underlying issues.
Clubbing of the Nails
Clubbing of the nails is a thickening of the soft tissue beneath the proximal nail plate, resulting in sponginess and thickening of the proximal plate and the digit. This can be caused by pulmonary disease, inflammatory bowel disease, or lung cancer. The condition may also be caused by megakaryocytes and platelet clumps that have escaped filtration in the pulmonary bed and entered the systemic circulation. The angle between the finger proximal to the nail and the proximal nail plate is straightened, creating the "Schamroth sign".
Koilonychia
Koilonychia, or "spoon-shaped" nails, can be a sign of iron deficiency. However, they may also indicate hemochromatosis or anaemia.
Onycholysis
Onycholysis, or nail lifting, can be a sign of hyperthyroidism, especially when there is no history of trauma or psoriasis.
Beau's Lines
Beau's lines are horizontal indentations in the nail and may indicate a previous severe illness, trauma, or exposure to cold temperatures in patients with Raynaud's disease.
Muehrcke's Lines
Muehrcke's lines are white lines or bands on the nails and can indicate low albumin levels.
Splinter Haemorrhages
Small, linear red, purple, or brown lines in the nail can be a sign of endocarditis in patients with a heart murmur and unexplained fever.
Telangiectasia, Koilonychia, and Pitting
Telangiectasia, or dilated small blood vessels, along with koilonychia and pitting of the nails, may indicate connective tissue disorders.
Azure Lunula
A blue coloration of the lunula, known as azure lunula, can be a sign of Wilson's disease or hepatolenticular degeneration.
Terry's Nails
Terry's nails present as white nail plates with darker rims, indicating liver problems such as hepatitis.
Yellow Nails
Yellow nails can be a sign of a fungal infection, lung disease, rheumatoid arthritis, severe thyroid disease, diabetes, or psoriasis.
Brown or Black Nails
Brown or black nails can be a sign of excessive fluoride ingestion or silver poisoning.
Melanonychia
Dark streaks on the nails, known as melanonychia, can be a sign of skin cancer, infection, or injury.
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Trauma
A subungual hematoma, or a bruised nail, is a common injury that results from direct trauma to the nail. It involves bleeding below the hard part of the nail, which leads to swelling, nail discolouration, and pain. The blood collects under the nail, causing pressure and pain. This type of injury can also be caused by repetitive pressure, such as running in shoes that are too tight. The injury damages the blood vessels in the nail bed, which start to leak blood, with nowhere to go but to pool and put pressure on the nail plate. This can cause bacterial infections.
Nail injuries can be noticeable until the damaged nail grows out, which can take about two months for fingernails and four months for toenails. If the injury includes the base of the nail, some cosmetic changes may be permanent. If the trauma injures the nail matrix, a ridge or split can develop. If the matrix heals normally, this deformity will disappear as the nail regrows.
If blood is occupying more than half of the nail area, a physician should evaluate the finger as it could indicate a more serious underlying issue, such as a bone fracture or tissue tear. A doctor should also evaluate bleeding under the nail that is not caused by trauma.
In some cases, dark nails may be a sign of a more serious condition, such as melanoma or a fungal infection. Melanonychia, the term for dark pigmentation of the nails, can be a natural occurrence in people with dark skin, but it can also indicate health issues. It can be caused by trauma to the nail plate, such as friction from nail-biting, pulling, or tight-fitting shoes or gloves.
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Frequently asked questions
Dark nails can be caused by a number of factors, including skin cancer, infection, injury, or vitamin deficiencies. If you notice dark nails, it is important to see a doctor or dermatologist for a proper diagnosis.
Melanonychia, a condition where brown or black lines appear on the nails due to increased melanin production, can be a cause of dark nails. This can be caused by various factors, including race, pregnancy, fungal infection, or certain medications.
Yes, dark nails can be a sign of an underlying health condition, such as systemic diseases like Addison's disease or Cushing's syndrome. It can also be a result of iron deficiency or certain habits like nail-picking or nail biting.
If you notice any changes in the color, texture, or shape of your nails, it is recommended to consult a board-certified dermatologist for a proper diagnosis. Early detection can help in treating any underlying conditions effectively.
