Liam Carter
Dark lines on the nails, known as melanonychia, can be a cause for concern and may indicate an underlying health condition. Melanonychia is the occurrence of brown or black stripes that start at the bottom of the nail bed and continue to the top. It can affect one or multiple nails and is usually the result of increased melanin deposits in the nail or changes in nail pigmentation. While melanonychia may be benign, it can also indicate a more serious health issue such as melanoma, a dangerous form of skin cancer, or other health conditions like nutritional deficiencies, trauma, or infections. It is important to consult a healthcare professional if you notice any changes in your nails, especially if they occur without an obvious cause, to ensure proper diagnosis and treatment.
| Characteristics | Values |
|---|---|
| Name | Melanonychia, Splinter Hemorrhages |
| Description | Dark lines on your fingernails or toenails |
| Causes | Melanocytic activation, Melanocytic hyperplasia, Trauma, Inflammation, Malnutrition, Tumors, Infections, Medication, Race, Pregnancy, Systemic disease |
| Treatment | Doctors may perform a biopsy, dermatoscopic exam, or physical exam. If caused by an injury, it may not require treatment. |
| Prevention | Regular skin checks, including nails, are recommended by the American Academy of Dermatology Association (AADA) to detect early signs of skin cancer. |
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What You'll Learn
- Melanonychia: a brown or black stripe that begins at the bottom of the nail bed and continues to the top
- Splinter haemorrhages: tiny streaks of blood under the nail plate that resemble thin wooden splinters
- Melanocytic activation: an increase in the production and deposits of melanin in the nail
- Melanocytic hyperplasia: an increase in pigment cells in the nail bed, which can be benign or malignant
- Underlying health conditions: dark lines on multiple nails can indicate a systemic cause, such as endocarditis
Melanonychia: a brown or black stripe that begins at the bottom of the nail bed and continues to the top
Melanonychia is a condition that causes a brown or black stripe to appear on the nail bed, extending to the top of the nail. It can affect both finger and toenails and can appear in one nail, several nails, or all nails. This condition occurs due to increased melanin deposits in the nail or changes in nail pigmentation. Melanin is produced by pigment cells called melanocytes.
There are several types of melanonychia:
- Longitudinal melanonychia, or melanonychia striata, appears as brown, black, or grey bands running from the nail bed to the tip of the nail.
- Diffuse or total melanonychia involves the entire nail turning dark.
- Transverse melanonychia appears as a band running horizontally across the nail.
Melanonychia can have various causes, ranging from harmless to potentially fatal. It may occur naturally in individuals with a dark complexion or due to pregnancy, infections, inflammatory skin diseases, or certain medications. However, it can also be a sign of more serious health conditions, including nail cancer, trauma, nutritional deficiencies, or other underlying health issues. Therefore, it is recommended to consult a doctor for a thorough examination and diagnosis if you notice any dark streaks on your nails.
To diagnose melanonychia, healthcare professionals may review your medical history, examine your nails, perform a dermatoscopic exam using a microscope, or conduct a nail biopsy to determine the underlying cause and provide appropriate treatment.
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Splinter haemorrhages: tiny streaks of blood under the nail plate that resemble thin wooden splinters
Dark lines on your nails can be caused by splinter haemorrhages, melanonychia, or Beau lines. Here is some information on splinter haemorrhages: tiny streaks of blood under the nail plate that resemble thin wooden splinters.
Splinter haemorrhages are small areas of bleeding (haemorrhaging) under your nails. They are called splinter haemorrhages because they resemble thin, red or reddish-brown lines below your nails that are 1 to 3 millimetres long. They run vertically in the direction of your nail growth. They are usually closer to the end of your nails, but any part of your nail may be affected. They are often caused by damage to the small blood vessels underneath your nail. This damage can be caused by trauma or injury to your nail, which is the most common cause of splinter haemorrhages. They can also be caused by underlying health conditions, such as endocarditis, antiphospholipid syndrome, lupus, chronic kidney disease, or cancer. If you have splinter haemorrhages on more than one nail, it may be a sign of a more serious underlying condition.
If you have not sustained an injury, you should contact your healthcare provider to determine the underlying cause of the splinter haemorrhages. Your healthcare provider may prescribe medication or recommend an over-the-counter option if you have an underlying disease. However, if the splinter haemorrhages are caused by an injury, they do not usually require treatment and will go away within a few days or as your nail grows out.
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Melanocytic activation: an increase in the production and deposits of melanin in the nail
Melanonychia, or black or brown lines on your nails, can be caused by melanocytic activation, which is an increase in the production and deposits of melanin in the nail. This increase in melanin deposits results in a stripe of brown or black that appears as the nail grows. This is different from melanocytic hyperplasia, which is an increase in pigment cells in the nail bed. Melanocytic activation does not involve an increase in pigment cells.
Melanocytic activation can be caused by several factors. One factor is race, as melanonychia can naturally occur in people with darker skin tones. Melanonychia can also be caused by pregnancy, as skin hyperpigmentation changes occur during this time. Infections, such as fungal, bacterial, or viral infections, can also lead to melanocytic activation. Additionally, certain pathogens involved in onychomycosis or paronychia can trigger an inflammatory response that induces melanocytic activation. Gram-negative bacterial pathogens such as Proteus mirabilis and some dermatophyte strains like trichophyton rubrum can produce melanin and present as linear streaks.
Trauma or injury to the nail can also cause melanocytic activation. This includes acute or chronic trauma, such as repeated friction from nail-biting or ill-fitting shoes. Nutritional deficiencies, especially a lack of protein, vitamin D, or vitamin B12, can also lead to melanocytic activation. Additionally, certain medications have been implicated, such as those used to treat HIV/AIDS, malaria, and cancer.
It is important to note that while melanonychia may be harmless, it can also indicate a more serious health condition, such as nail cancer or melanoma. Therefore, it is recommended to consult a doctor for a thorough examination and diagnosis if you notice any dark streaks on your nails. A healthcare professional will review your medical history and perform a physical examination to determine the underlying cause of melanonychia.
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Melanocytic hyperplasia: an increase in pigment cells in the nail bed, which can be benign or malignant
Melanonychia is the appearance of brown or black lines on the nail plate. It can affect both the fingernails and toenails and can occur in one nail, several nails, or all nails. The lines usually start at the bottom of the nail bed and continue to the top.
Melanonychia occurs when pigment cells, called melanocytes, deposit melanin, a brown-coloured pigment, into the nail. Melanonychia can be caused by two primary processes: melanocytic activation and melanocytic hyperplasia.
Melanocytic hyperplasia refers to an increased number of melanocytes within the nail matrix. This can be benign or malignant. Melanocytic activation, on the other hand, is an increase in the production and deposition of melanin into the nail cells without an increase in the number of melanocytes. Causes of melanocytic activation include trauma, nutritional deficiency, medication, and certain infections.
Melanocytic hyperplasia can be further classified into two types: melanocytic nevi and lentigines. Melanocytic nevi are more common in children and are characterised by nests of naevus cells. Lentigines, on the other hand, are more commonly seen in adults and are characterised by the absence of nests.
It is important to note that melanoma of the nail bed is the most serious possible cause of melanonychia. Nail melanoma can look like a streak or band on the nail and is often found on the thumb or big toe of the dominant hand or foot. Doctors use the ABCDEF criteria to diagnose melanoma under the nail, considering factors such as age, width of the band, changes in size or growth rate, family history, and more.
If you notice any dark streaks on your nails, it is recommended to consult a doctor for a thorough examination and diagnosis.
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Underlying health conditions: dark lines on multiple nails can indicate a systemic cause, such as endocarditis
Dark lines on the nail can be indicative of an underlying health condition, such as endocarditis. Endocarditis is an infection of the heart's inner lining, which can cause coughing and even lead to heart failure. It is typically the result of a bacterial infection.
Endocarditis can cause thin red or reddish-brown lines under the fingertips, known as splinter hemorrhages. These marks are a sign that either the blood vessels have become swollen and damaged or small clots have injured the capillaries under the nails. Splinter hemorrhages are longitudinal thin lines that occur beneath the nail plate when capillaries within the epidermal ridges leak. They are visible in one or more places under the nail and are a classic finding in patients with endocarditis. They are thought to be a more specific indicator of endocarditis if they are present proximally rather than distally on the nail plate. However, they are relatively rare, occurring in only about 15% of patients with endocarditis.
People are more likely to develop endocarditis if they have a weakened immune system, heart valve disease, a long-term central venous line, poor dental hygiene habits, a history of IV drug use, or a previous case of endocarditis. Early symptoms of endocarditis typically involve flu-like symptoms, including fever, chills, and nausea. As the condition progresses, it has the potential to affect other parts of the body.
If you notice dark lines on multiple nails, it is important to consult a doctor as it may indicate an underlying health condition such as endocarditis. A doctor can perform a thorough examination and diagnosis to determine the cause of the nail discolouration. Treatment of nail discolouration will vary based on the underlying cause.
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Frequently asked questions
Black streaks on your nails can be caused by several factors, including melanonychia, splinter hemorrhages, or nail melanoma. Melanonychia occurs when there is an increase in melanin deposits in the nail, resulting in brown or black stripes. Splinter hemorrhages are tiny streaks of blood under the nail caused by trauma or underlying health conditions. Meanwhile, nail melanoma is a serious form of skin cancer that can cause black bands on the nails. It is important to consult a doctor to determine the exact cause and receive appropriate treatment.
Melanonychia can be caused by melanocytic activation or melanocytic hyperplasia. Melanocytic activation leads to increased melanin production and deposits in the nail without an increase in pigment cells. Melanocytic hyperplasia, on the other hand, involves an increase in pigment cells in the nail bed, which can be benign or malignant. Melanonychia may also be influenced by factors such as race, pregnancy, infections, and certain medications.
Nail melanoma, also known as subungual melanoma, can present with several symptoms. These include a black or brown band on the nail, often on the dominant thumb or big toe, darkened skin around the nail, nail splitting or lifting, and a bump under the nail. It is important to note that melanoma of the nail bed is the most serious potential cause of melanonychia, and regular skin checks are recommended for early detection.
The treatment of melanonychia depends on the underlying cause. If it is caused by a benign condition, it may not require treatment. However, if it is malignant or cancerous, the tumour or cancerous area must be removed, which may involve losing part or all of the nail. A nail biopsy is often performed to confirm the diagnosis and determine the appropriate treatment.
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