Nail Discoloration

Aka: Nail Discoloration, Leukonychia, Melanonychia, Chromonychia, White Nails, Yellow Nails, Black Nails, Red Nails, Blue Nails

II. Definitions: Chromonychia

  1. Color changes of nails

III. Causes: White Nail - Leukonychia (partial or complete)

  1. Anemia (most common)
  2. Congenital (Autosomal Dominant)
    1. Abnormal keratinization of underlying nail matrix
    2. Results in nail plate white discoloration of one or multiple nails with all or partial nail involvement
    3. No Clinical Significance (normal variant in adults and children)
  3. Terry's Nails (all White Nails except the distal 1-2 mm nail edge)
    1. Chronic Liver Disease
    2. May also occur with Diabetes Mellitus, Congestive Heart Failure, Hyperthyroidism, Aging
  4. Half and Half Nails (Lindsay's Nails, white proximal, pink/red distal)
    1. Chronic Renal Failure
  5. Transverse Linear Nail Lesions
    1. Muehrcke's Lines
    2. Mees' Lines
    3. Transverse striate Leukonychia (white lines)
      1. Minor nail matrix or cuticle Trauma
  6. Leukonychia punctata (white spots)
    1. Minor Trauma to Nail Cuticle or matrix

IV. Causes: Miscellaneous Color Changes

  1. Green Nails (Chloronychia)
    1. Pseudomonas pyocyanea or pseudomonas aeruginosa infection
  2. Red Nails
    1. Nail Telangiectasia
    2. Congestive Heart Failure

V. Causes: Blue Nails

  1. Medication Side Effect
    1. Quinacrine
    2. Chloroquine
    3. Minocycline (Minocin)
    4. Doxorubicin (Adriamycin)
    5. Melphalan, Bleomycin, Daunorubicin
  2. Wilson's Disease (Azure lunula)
  3. Ochronosis
  4. Psoriasis
  5. Alopecia Areata
  6. Silver Poisoning (Argyria)

VI. Causes: Black Nails (Melanonychia) or dark longitudinal streaks

  1. See Nail Abnormality for other longitudinal striations
  2. Nail Hyperpigmentation is common
    1. Black patients have a 75% Prevalence of benign nail Hyperpigmentation
    2. However, involvement of a single nail (esp. first), and esp. in a linear arrangement is concerning
      1. Represents Subungual Melanoma in 5% of caucasian and 15-20% of black, asian
  3. Subungual Melanoma
    1. Most important diagnosis to exclude
  4. Vertical Nail Bands (Longitudinal Melanonychia)
    1. Hyperpigmented bands occur as normal variant in 90% of black patients
    2. Distinguish from Subungual Melanoma (see below)
  5. Medication Side Effects
    1. Cyclophosphamide (Cytoxan)
    2. Excessive Fluoride Supplementation (Fluorosis)
  6. Melanonychia striata
    1. Common in dark skinned persons
    2. Spontaneous or secondary to Trauma or Chemotherapy
  7. Benign Nevus
    1. Uniform brown longitudinal streak localized to nail
  8. Chronic Renal Failure
    1. Distal nail bed discolored brown

VII. Causes: Yellow Nails

  1. Yellow Nail Syndrome
  2. Onychomycosis
  3. Psoriasis
  4. Alopecia Areata
  5. Raynaud's Syndrome
  6. Hyperthyroidism
  7. Tetracycline

VIII. References

  1. Jhun, Raam and DeClerck in Herbert (2015) EM:Rap 15(12): 3-4
  2. Fawcett (2004) Am Fam Physician 69(6):1417-24 [PubMed]

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Related Studies

Ontology: Nail discoloration (C0221345)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Nail Disorders

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