Caleb Foster
Dark lines on your nails can be a symptom of a condition known as linear melanonychia, which is relatively common and accounts for about half of all nail discolouration cases. Melanonychia occurs when the skin overproduces melanin or pigment-producing cells (melanocytes) and can be caused by various factors, including medication, health conditions, trauma, and nutritional deficiencies. Melanonychia may appear as a brown, black, or grey band that runs from the nail bed to the tip of the nail. It is recommended to consult a doctor for a thorough examination and diagnosis if you notice any dark streaks in your nails, as it may indicate a more serious health condition.
| Characteristics | Values |
|---|---|
| Name | Melanonychia, Linear Melanonychia, Melanonychia Striata, Longitudinal Melanonychia |
| Description | Black or brown lines in the fingernails or toenails |
| Causes | Melanocytic activation, melanocytic proliferation, trauma, nutritional deficiency, medication, nail injury, infection, cancer, fungal infection, inflammation, vitamin deficiency, pregnancy, chemotherapy, inflammatory skin disease, friction from shoes, nail biting, endocrine disorders, moles, skin pigmentation |
| Treatment | A doctor can perform exams and a biopsy to determine if it is malignant. If malignant, the cancerous area must be removed. |
| Prevention | Regular skin checks, including nails, to detect early signs of skin cancer |
| Other names | Splinter Hemorrhages, Subungual Melanoma |
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What You'll Learn
- Melanonychia, a brown or black colour in your nail, can be caused by melanocytic activation or proliferation
- Splinter hemorrhages are tiny streaks of blood caused by damage to blood vessels under the nail
- Endocarditis, a bacterial infection in the heart, can cause black lines on multiple nails
- Black lines on the nail can be a sign of melanoma, a serious form of skin cancer
- Inflammatory skin conditions, such as lichen planus, can cause black streaks on nails
Melanonychia, a brown or black colour in your nail, can be caused by melanocytic activation or proliferation
Melanonychia is characterised by brown or black discolouration in the nail plate. It can affect your fingernails or toenails and can appear in one nail, a few nails, or all of your nails. The discolouration usually looks like a stripe that begins at the bottom of your nail bed and continues to the top.
Melanonychia occurs when the pigment cells, called melanocytes, deposit melanin — a brown-coloured pigment — into the nail. Melanonychia can be caused by two primary processes, which have different causes.
One of the processes that cause melanonychia is melanocytic activation, which refers to an increase in the production and deposits of melanin in your nail, but not an increase in pigment cells. This can be caused by melanocyte activation following trauma, infection, or inflammation, which initiates melanin synthesis. The melanin-rich melanosomes are then transferred to the differentiating matrix cells through dendrites. These matrix cells migrate distally and eventually turn into nail plate onychocytes, resulting in visible pigmentation in the nail plate. Melanocytic activation can also be caused by inflammatory skin conditions like psoriasis, lichen planus, amyloidosis, chronic radio dermatitis, and chronic paronychia in and around the nail unit.
The other process that causes melanonychia is melanocytic proliferation, which refers to an increase in pigment cells in your nail bed. This growth can be benign or malignant. Benign causes of melanocytic proliferation include nevi, which are moles, and lentigo, which are flat, pigmented areas of skin. Melanoma of the nail bed is the most serious possible cause of melanonychia.
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Splinter hemorrhages are tiny streaks of blood caused by damage to blood vessels under the nail
Black streaks on your fingernails can be a symptom of splinter hemorrhages. Splinter hemorrhages are tiny streaks of blood underneath your nail plate that resemble thin wooden splinters. They are usually 1 to 3 millimetres long and appear closer to the end of your nails, but any part of your nail may be affected.
Splinter hemorrhages are caused by damage to the small blood vessels under your nail bed. Trauma to the nail is the most common cause of this condition. This could be caused by hitting your nail, prolonged pressure, or habits like nail biting. They can also be caused by underlying health conditions. For example, they are commonly seen in people with nail psoriasis and lichen planus. Up to 35% of people with lichen planus reported having splinter hemorrhages.
If you have experienced trauma to the nail, splinter hemorrhages will likely grow out over time and do not usually require treatment. However, if you are experiencing symptoms besides the nail condition, you should see a doctor for a thorough examination and diagnosis. Your doctor will likely ask about your symptoms and medical history, and may request a test called a dermoscopy to help diagnose the condition.
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Endocarditis, a bacterial infection in the heart, can cause black lines on multiple nails
Black streaks on your fingernails can be indicative of various conditions, one of which is endocarditis. Endocarditis is a bacterial infection that affects the inner lining of the heart, specifically the heart valves and chambers. This rare condition can be life-threatening and requires prompt medical attention.
Endocarditis occurs when bacteria enter the bloodstream and attach to damaged areas in the heart, such as diseased or artificial heart valves. These bacteria can originate from various sources, including poor dental health, long-term catheter use, or illegal intravenous drug use. Once in the bloodstream, the bacteria can travel to the heart and cause inflammation and infection.
While endocarditis initially presents with flu-like symptoms such as fever, chills, and nausea, it can also cause splinter hemorrhages, which are thin red or reddish-brown lines under the fingernails. These lines occur due to damaged blood vessels or small clots that injure the capillaries under the nails. As the splinter hemorrhages progress, they can turn into black lines on multiple nails, indicating a systemic issue.
If you notice black lines on your nails, especially if accompanied by other symptoms, it is important to seek medical advice promptly. Healthcare providers may perform a physical examination, review your medical history, and possibly order tests such as a chest X-ray, electrocardiogram (ECG or EKG), or echocardiogram to confirm the diagnosis and determine the appropriate treatment.
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Black lines on the nail can be a sign of melanoma, a serious form of skin cancer
If you notice a black line on your nail, it is important to see a doctor, as it could be a sign of a serious health condition. A doctor can examine your nails and perform tests to determine the underlying cause. Melanoma of the nail bed is the most serious possible cause of black lines on the nails and requires prompt medical attention. Doctors use the ABCDEF criteria to diagnose melanoma under a nail, considering factors such as age, the width of the band of colour, and the regularity of the border.
In addition to melanoma, black lines on the nail can also be caused by a condition called melanonychia, which is characterised by black or brown discoloration of the nail plate. This condition occurs when the skin overproduces melanin or pigment-producing cells (melanocytes). It can affect one or multiple nails and may appear as linear melanonychia, total melanonychia, or transverse melanonychia. Linear melanonychia presents as a black or brown line running vertically along the nail bed, while total melanonychia involves the entire nail bed turning dark, and transverse melanonychia appears as a horizontal band across the nail bed.
Another possible cause of black lines on the nail is splinter hemorrhages, which are tiny streaks of blood underneath the nail plate. These can occur due to trauma or injury to the nail, causing tiny blood vessels beneath it to break and bleed. Splinter hemorrhages usually heal on their own and do not require treatment. However, if you experience multiple splinter hemorrhages across several nails, it could indicate an underlying condition, and you should consult a healthcare professional.
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Inflammatory skin conditions, such as lichen planus, can cause black streaks on nails
Melanonychia is the name given to the presence of black or brown lines on your fingernails or toenails. It is caused by the activation of pigment cells, called melanocytes, which deposit melanin, a brown-coloured pigment, into the nail. Melanonychia can develop due to several causes, including nail trauma, cancer, medication, and inflammatory skin conditions, such as lichen planus.
Lichen planus is an inflammatory skin condition that often results in an itchy rash. It is a common skin rash that can also affect your mouth and nails. It is neither dangerous nor contagious, and it usually goes away on its own. However, it can make you feel self-conscious, and it can be unpleasant if it itches. Lichen planus can cause nail colour changes, brittleness, cracking, splitting, and nail loss. It can also lead to nail ridges running lengthwise, which can appear as black streaks.
Lichen planus is a disease of unknown cause and is challenging to cure. It is not caused by stress, but emotional stress can worsen the condition. It is also not infectious and cannot be passed from one person to another. Certain drugs, such as medications for high blood pressure, heart disease, diabetes, arthritis, and malaria, have been linked to lichen planus. Additionally, people with oral lichen planus may be allergic to certain products used in dental procedures, such as amalgam fillings.
If you notice black streaks on your nails, it is important to consult a healthcare professional. They can assess your symptoms, conduct a physical examination, and determine the underlying cause.
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Frequently asked questions
Black streaks in your fingernails could be indicative of a splinter hemorrhage, which is caused by damage to the small blood vessels underneath your nail. This is usually the result of trauma or injury.
Splinter hemorrhages are tiny streaks of blood that resemble thin wooden splinters. They are usually 1 to 3 millimeters long and appear closer to the end of your nails, but they can show up anywhere on the nail.
Most of the time, splinter hemorrhages do not require treatment and will heal on their own within a few days.
The black streaks could be indicative of a more serious condition called melanonychia, which is characterized by black or brown discoloration of the nail. This can be caused by several factors, including trauma, nutritional deficiencies, medication, or melanoma.
If the black streaks appear as a band that runs horizontally across your nail, it is more likely to be melanonychia. It is important to consult a doctor if you notice any unusual symptoms or changes in your nails, as they can examine and diagnose the cause of the black streaks.
