Ava Monroe
Dark nails can be alarming, especially when you notice a black or brown line underneath your fingernail. This condition is called melanonychia and can affect one or multiple nails. There are various causes for this phenomenon, ranging from physical trauma to the nail, medication, and nutritional deficiencies to more serious conditions like melanoma. It is important to consult a doctor or dermatologist to determine the underlying cause and receive appropriate treatment.
| Characteristics | Values |
|---|---|
| Cause | Trauma to the nail bed, nail injury, infection, fungal infection, bacterial infection, viral infection, inflammation, melanoma, medication, nutritional deficiencies, pregnancy, or malignancy |
| Symptoms | Black or brown lines, spots, or stripes on the nail; pain, swelling, nail deformities, or drainage |
| Diagnosis | Dermatoscopic exam, biopsy, medical history review, and other exams |
| Treatment | Analgesic medications, drainage of trapped blood, surgery, or targeted treatment |
| Prevention | Avoid tight shoes or gloves, biting nails, or pulling out nails |
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What You'll Learn
Trauma to the nail bed
The treatment for a subungual hematoma depends on the severity of the injury. In most cases, a simple drainage procedure can be performed to relieve pain and support healing. This involves creating a small hole in the nail, usually with a needle, to drain the trapped blood. It is important to note that this procedure should not be attempted at home, and medical care should be sought. If the hematoma is causing severe pain or covers more than 50% of the nail, nail removal and/or clot evacuation may be necessary. Additionally, if there is a deep tear, stitches may be required to repair the injury.
While nail bed injuries can often be fully repaired, severe trauma can lead to nail deformities. For example, a hook nail can occur when the nail does not have enough bony support and curves around the finger. This can be treated by removing the nail and trimming the nail matrix, which is the tissue the nail rests on. Another possible complication is a split nail, which happens when the nail cannot grow over scar tissue. Treatment for this complication involves removing the affected nail and treating or removing the scar to allow for proper nail regrowth.
It is important to seek medical attention for any nail bed injury, especially if there is bleeding under the nail that is not caused by trauma. Additionally, keeping fingernails trimmed and avoiding biting them or cutting the cuticles can help prevent nail bed injuries and reduce the risk of nail-related complications.
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Melanoma
Subungual melanoma can be challenging to detect early because the signs are not always noticeable. It often starts as a brown or black streak under a toenail or fingernail, which may be mistaken for a bruise. This dark streak can show up on any nail but is most common on the index finger, thumb, or big toe. The darkening tends to increase in size over time and can potentially turn the entire nail black.
Other signs of subungual melanoma include dark skin next to the nail, nail lifting from the fingers or toes, nail splitting, and a bump or nodule under the nail. The presence of pigmented bands on the nail, known as Hutchinson's sign, is also a key indicator of subungual melanoma. This sign occurs when nail pigmentation extends onto the skin surrounding the nail.
If you notice any of these signs or changes to your nails, it is important to consult a dermatologist. They may perform a dermatoscopic exam using a microscope to closely examine the discolored areas. They may also perform a biopsy of the nail to confirm the diagnosis. Treatment for nail melanoma typically involves surgical removal of the malignant tissues, which may include removing part or all of the nail or digit.
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Medication side effects
Melanonychia is the medical term for black or brown lines on your fingernails or toenails. It can affect one or multiple nails and can be caused by medication side effects. If medication is the cause, the discolouration usually appears soon after starting treatment.
Medications that can cause melanonychia include:
- Chemotherapy for cancer
- Antimalarials
- Biologics for inflammatory conditions
- Seizure medications such as phenytoin
- Antifungals such as fluconazole
- Drugs for mood disorders
- Drugs for Crohn's disease
- Light therapy for skin conditions
- Antiretroviral therapy for HIV/AIDS
If medication is the cause of melanonychia, a doctor may recommend changing the medication or stopping it for a period of time. For medications that cannot be stopped, melanonychia may be a side effect that the patient will have to get used to.
Another medication side effect that can cause black lines on the nails is photoonycholysis. This is an allergic or toxic effect of ultraviolet radiation that separates the nail plate from the nail bed. It is considered rare and usually regresses after discontinuation of the causative agent. Applying opaque nail polish and avoiding sun exposure can prevent this effect.
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Bacterial, viral, or fungal infections
Fungal nail infections, also known as onychomycosis or tinea unguium, can be caused by various fungi, including dermatophytes, that enter through small cracks in the nail or the surrounding skin. These infections are more common in toenails than fingernails due to the warm, moist environment created by shoes. Distal subungual infections are the most common type, resulting in white and/or yellow streaks across the nail. Proximal subungual infections are less common and usually affect individuals with compromised immune systems. Fungal nail infections can lead to nail discoloration, brittleness, thickening, and crumbling. Treatment options include oral antifungal medications, topical antifungals, and, in severe cases, surgical removal of the nail.
It is important to note that viral infections were not specifically mentioned in the search results as a cause of black discoloration underneath the fingernail. However, bacterial and fungal infections, as described above, can lead to such discoloration and are important considerations when addressing nail health.
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Nutritional deficiencies
While nail issues often occur due to injury or overexposure to moisture, nail health can be an indicator of nutritional deficiencies or poor digestion. Nutritional deficiencies can cause nail changes, including brittle, weak, rough, and smooth nails, as well as nails that are not growing properly or have grooves.
Zinc Deficiency
Zinc deficiency can cause horizontal white lines across the nail bed, known as striata leukonychia, and scattered white spots on the nails. It can also lead to horizontal depressions across the fingernails, known as Muehrcke's lines, which are associated with low protein levels in the blood. Additionally, zinc deficiency can cause koilonychia, or spoon nails, where the nail bed curves inward like a spoon.
Iron Deficiency
Iron deficiency can lead to koilonychia, where the nail flattens and curves inward, with raised ridges. This condition is also associated with iron deficiency anaemia, where the nail becomes thin and brittle. Iron-deficient nails may also be dry and prone to breaking.
Vitamin C Deficiency
Vitamin C deficiency can cause splinter haemorrhages, which appear as thin red, brown, or blackish lines under the nails. These lines run longitudinally along the direction of nail growth and are caused by trauma to the small blood vessels underneath the nail bed.
Vitamin B Deficiency
Vitamin B deficiency, especially B vitamins that promote cell growth, can cause vertical ridges or longitudinal furrows running from the tips of the nails to the cuticles.
Calcium Deficiency
Calcium deficiency can lead to Beau's lines, which are deep horizontal grooves that travel from one side of the nail to the other.
Protein Deficiency
Protein deficiency can also cause koilonychia, or spoon nails.
Malnutrition
Malnutrition can lead to nail changes, including soft and thin nails, impaired nail growth, and longitudinal melanonychia, which refers to blackish discolouration of the nail plate.
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Frequently asked questions
There are several reasons why your fingernail may be black underneath. It could be due to a fungal infection, known as onychomycosis or tinea unguium, or it could be the result of an injury or trauma to the nail. In some cases, it may be a sign of a more serious condition, such as melanoma or nail cancer. It is important to consult a doctor or dermatologist to determine the exact cause and receive proper treatment.
Yes, several medications can induce black discoloration under the fingernail, including antimalarials, chemotherapeutics, and phenytoin. Additionally, nutritional deficiencies, such as a lack of vitamin B12, vitamin D, or protein, can also cause dark lines or spots under the nail.
If you notice black discoloration under your fingernail, it is recommended to consult a doctor or dermatologist, especially if the discoloration worsens or persists. They will be able to examine your nails, review your medical history, and perform any necessary tests to determine the underlying cause and provide appropriate treatment.
