II. Definitions
- Chromonychia (dyschromia)
- Color changes of nails
III. Causes: White Nail - Leukonychia (partial or complete)
- Anemia (most common)
- Congenital (Autosomal Dominant)
- Abnormal keratinization of underlying nail matrix
- Results in nail plate white discoloration of one or multiple nails with all or partial nail involvement
- No Clinical Significance (normal variant in adults and children)
-
Terry's Nails (all White Nails except the distal 1-2 mm nail edge)
- Chronic Liver Disease
- May also occur with Diabetes Mellitus, Congestive Heart Failure, Hyperthyroidism, Aging
- Half and Half Nails (Lindsay's Nails, white proximal, pink/red distal)
-
Transverse Linear Nail Lesions
- Muehrcke's Lines
- Mees' Lines
- Transverse striate Leukonychia (white lines)
- Minor nail matrix or cuticle Trauma
- Leukonychia punctata (white spots)
- Minor Trauma to Nail Cuticle or matrix
IV. Causes: Miscellaneous Color Changes
-
Green Nails (Chloronychia)
- Pseudomonas pyocyanea or Pseudomonas aeruginosa infection
- Red Nails
V. Causes: Blue Nails
- Medication Side Effect
- Quinacrine
- Chloroquine
- Minocycline (Minocin)
- Doxorubicin (Adriamycin)
- Melphalan, Bleomycin, Daunorubicin
- Wilson's Disease (Azure lunula)
- Ochronosis
- Psoriasis
- Alopecia Areata
- Silver Poisoning (Argyria)
VI. Causes: Diffusely Black Nails (Melanonychia), Hyperpigmentation or Dark Longitudinal Streaks
- See Nail Abnormality (includes other longitudinal striations)
- See Hyperpigmentation
- Nail Hyperpigmentation is common
- Black patients have a 75% Prevalence of benign Nail Hyperpigmentation
- However, involvement of a single nail (esp. first), and esp. in a linear arrangement is concerning
- Represents Subungual Melanoma in 5% of caucasian and 15-20% of black, asian
-
Subungual Melanoma
- Most important diagnosis to exclude (esp. if isolated, single nail involvement)
-
Vertical Nail Bands (Longitudinal Melanonychia)
- Hyperpigmented bands occur as normal variant in 90% of black patients
- Distinguish from Subungual Melanoma (see below)
- Melanonychia striata
- Common in dark skinned persons
- Spontaneous or secondary to Trauma or Chemotherapy
- Benign Nevus
- Uniform brown longitudinal streak localized to nail
-
Chronic Renal Failure
- Distal nail bed discolored brown
- Melanoderma
- Diffuse skin Hyperpigmentation may also affect the nails
- Other Causes
- Hyperpigmentation in Pregnancy
- Nutritional Deficiency
- Miscellaneous Medication Side Effects
- Excessive Fluoride Supplementation (Fluorosis)
- Antimalarials
- Phenytoin
- Tetracycline
- Chemotherapeutics
- Connective Tissue Disease
- Endocrinopathy
VII. Causes: Yellow Nails
VIII. References
- Jhun, Raam and DeClerck in Herbert (2015) EM:Rap 15(12): 3-4
- Fawcett (2004) Am Fam Physician 69(6):1417-24 [PubMed]
- Hashimi (2023) Am Fam Physician 107(3): 305-6 [PubMed]
- Mendiratta (2011) Indian J Dermatol Venereol Leprol 77(6):652-8 +PMID: 22016271 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI_CTCAE) | A disorder characterized by a change in the color of the nail plate. |
Definition (NCI) | A change in the color of the nail. |
Concepts | Finding (T033) |
SnomedCT | 267861009, 89077005 |
English | NAIL DISCOLORATION, NAIL DISCOLOURATION, Nail discoloration, discoloration of nails, nail discoloration, nail discoloration (physical finding), Discoloration nail, Nail Discoloration, discoloration nail, discoloration nails, discolouration nail, nail discolouration, discolorations nail, Discolouration nail, Chromonychia, Pigmentary Change of Nails, Nail discolouration, Nail discoloration (finding), discoloration; nails |
Spanish | alteración de la coloración ungueal, alteración de la coloración ungueal (hallazgo), Discoloración ungueal, Cambio de color de uñas, decoloración de las uñas (hallazgo), decoloración ungular, UNAS, CAMBIO DE COLOR, decoloración de las uñas, Cambio de color de las uñas |
Dutch | verkleuring nagel, verkleuring; nagels, nagelverkleuring |
French | Décoloration des ongles, DYSCHROMIE UNGUEALE, Dyschromie unguéale |
German | Verfaerbung des Nagels, NAGELVERFAERBUNG, Nagelverfaerbung |
Portuguese | Alteração da cor das unhas, ALTERACAO DA COR DAS UNHAS, Descoloração das unhas |
Japanese | 爪変色, ソウヘンショク, ツメヘンショク |
Czech | Odlišné zbarvení nehtu, Diskolorace nehtu |
Italian | Alterazione del colore delle unghie |
Hungarian | Köröm elszíneződése, Köröm-elszíneződés, Elszíneződés köröm, Discoloratio unguum |
Ontology: Leukonychia (C0240182)
Definition (NCI) | Any white discoloration of the nails or nail plates. |
Concepts | Disease or Syndrome (T047) |
SnomedCT | 111202002 |
Dutch | leuconychia |
French | Leuconychie |
German | Leukonychie |
Italian | Leuconichia |
Portuguese | Leuconíquia |
Spanish | Leuconiquia, leuconiquia (trastorno), leuconiquia |
Japanese | 爪甲白斑, ソウコウハクハン |
English | nail discoloration white (leukonychia), leukonychia, leukonychia (physical finding), leuconychia, Claw whitened, Nail whitened, Leukonychia, Leuconychia, Leukonychia (disorder) |
Czech | Leukonychie |
Hungarian | Leukonychia |
Ontology: White nails (C0423827)
Concepts | Finding (T033) |
SnomedCT | 247508004 |
English | nail white, nails white, white nail, white nails, White nails, White nails (finding) |
Spanish | uñas blancas (hallazgo), uñas blancas |
Ontology: Melanonychia (C1142305)
Concepts | Finding (T033) |
SnomedCT | 402633003 |
Dutch | melanonychie |
French | Mélanonychie |
German | Melanonychie |
Italian | Melanonichia |
Portuguese | Melanoníquia |
Spanish | Melanoniquia, melanoniquia (trastorno), melanoniquia |
Japanese | 黒爪症, コクソウショウ |
Czech | Melanonychie |
English | melanonychia, Melanonychia striata, Melanonychia, Melanonychia (disorder) |
Hungarian | Melanonychia |
Ontology: Yellow nails (C1768507)
Concepts | Sign or Symptom (T184) |
SnomedCT | 247512005, 45342007 |
English | Yellow nails, yellow nails (symptom), yellow nails, Yellow nails (finding), Yellow nails (disorder) |
Spanish | síndrome de las uñas amarillas (trastorno), síndrome de las uñas amarillas |
Ontology: blue-gray nail plates (C2230175)
Concepts | Finding (T033) |
English | blue-gray nail plates, blue-gray nail plates (physical finding), blue-gray nail plates were seen |
Ontology: brown-black nail plates (C2230176)
Concepts | Finding (T033) |
English | brown-black nail plates, brown-black nail plates (physical finding), brown-black nail plates were seen |