12 nail changes a dermatologist should examine

Have you noticed a change to any of your nails lately? A change in color, texture, or shape can be harmless, but it can also be a sign of disease. If you notice any of the following changes to a fingernail or toenail, it’s time to see a board-certified dermatologist.

Medical name: Acral lentiginous melanoma

Dark streak
If a fingernail or toenail has a new or changing dark streak, it’s time to see a dermatologist for a skin cancer check. That dark streak could be melanoma, the most serious type of skin cancer.
Not every dark streak is a melanoma, but it’s always good to have a dermatologist examine one. Caught early and treated, that may be the only treatment you need.

Allowed to grow, treatment becomes more difficult.
Medical name: Onycholysis

• A fungal infection
• Psoriasis
• Injury from an aggressive manicure
• Injury form cleaning under your nails with a sharp object

Medical name: Paronychia

Redness and swelling around a nail
If you have redness and swelling around a nail, you may have an infection. When diagnosed early, you can often treat an infection with soaks and antibiotics. If an open sore forms, you’ll need more extensive treatment.
Medical name: Paronychia

Greenish black color
When bacteria cause a nail infection, the nail can turn greenish black as shown here.

Without treatment, a nail infection tends to worsen. Treatment can get rid of your pain and tenderness and help clear the infection.
Medical name: Pitting

Pitted nails
If you have dents in your nails that look like they were made by an icepick, this could be a sign that you have a disease that affects your entire body.

• Psoriasis
• Atopic dermatitis
• Alopecia areata

Medical name: Yellow nail syndrome

Yellow nails
Wearing red nail polish without a base coat or smoking can turn your nails yellow. If your nails turn yellow, thicken, and seem to stop growing, it could be a sign of something going on inside your body.

Lung disease and rheumatoid arthritis can cause yellow nails. You may also have a serious nail infection, which requires treatment.
Medical name: Beau lines

Deep grooves (or gaps)
Lines that run the length of a nail are common and usually nothing to worry about. If you see deep grooves that run the width of your nail like the ones shown in this picture, it means that something slowed (or stopped) your nails from growing for a while.

When something causes your nail(s) to completely stop growing for a while, you may see a gap. If this happens, you’ll have a place on your nail(s) that’s missing nail. The medical name for this condition is onychomadesis (on-ah-coe-ma-dee-sis).

A fever, injury, chemotherapy, or major stress can cause your nails to grow slowly or stop growing.

If you cannot think of what could may have caused your nails to grow slowly or stop growing, see your dermatologist or primary care doctor. Once you find and get rid of the cause, nails often start growing normally.
Medical name: Onychogryphosis

Ram’s horn nails
This happens when the nails thicken and overgrow. Some people get Ram’s horns because the condition runs in the family.

If you have a disease, such as psoriasis, ichthyosis, or circulation problems, you may also develop Ram’s horn nails.

Cutting and treating these nails requires help from a podiatrist or dermatologist.
Medical name: Koilonychia

• Lack of proper nutrition
• A health problem with their stomach or intestines
• Sensitivity to gluten (celiac disease)
• High altitude

Medical name: Onychotillomania

Washboard nails
If you have grooves and ridges in the center of your thumb that look like the ones shown in this picture, you may have developed a habit of picking at (or pushing back) the cuticles on your thumbnails. Many people are unaware that they do this.

A dermatologist may be able to help you break the habit, allowing healthy nails to grow out.
Medical name: Clubbing

Curved nails
The curving can begin so gradually that many people are unaware it’s happening. As the nails continue to curve downward, fingertips often swell and the nails start to feel spongy when pressed on.

• Lungs
• Heart
• Liver
• Stomach or intestine

Seeing a change to your nails or the half-moons doesn’t always mean that you have a disease.

Still, it’s important to see a board-certified dermatologist if you notice any changes. Board-certified dermatologists specialize in diagnosing and treating the skin, hair, and nails. They have the expertise to tell you whether the change is harmless or requires medical testing.

Related AAD resources

• Nail fungus
• What is nail psoriasis, and how can I treat it?
• Atopic dermatitis
• Alopecia areata

Images

• Images 4, 5, 7, 9, 10, and 11 used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
• Images 3, 12: Getty Images

Images from the Journal of the American Academy of Dermatology

• Image 2: J Am Acad Dermatol. 2014;70(4):748-62.
• Image 6: J Am Acad Dermatol. 2007;57:1-27.
• Image 8: J Am Acad Dermatol. 2015;73:849-55.

References
Braswell MA, Daniel CR, et al. “Beau lines, onychomadesis, and retronychia: A unifying hypothesis.” J Am Acad Dermatol 2015; 73:849-55.

Fawcett RS, Hart TM, et al. “Nail abnormalities: Clues to systemic disease.” Am Fam Physician. 2004;69(6):1417-24.

Kiaravuthisan MM, Sasseville D, et al. Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy.” J Am Acad Dermatol 2007;57:1-27.

Kumar V, Aggarwal S, et al. “Nailing the diagnosis: Koilonychia.” Perm J. 2012;16(3): 65.

Ring DS. “Inexpensive solution for habit-tic deformity.” Arch Dermatol. 2010;146(11):1222-3.

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