4.2.5 Nail Colour Changes

None

Causes vary according to colour.

Brown-black

• Medications: anti-malarials, cytostatic agents, antibiotics, psoralens, zidovudine in HIV infection

• Melanocytic: ethnic, melanocytic nevus, malignant melanoma

• Endocrine: Addison disease, Cushing disease

• Iron: hematoma, hemochromatosis

• Lupus erythematosus

• Infections, e.g. candida

• Splinters

Yellow-brown

• Psoriasis

• Onychomycosis

• Lichen planus

Green

• Pseudomonas aeruginosa

Yellow

• Onychomycosis

• Yellow nail syndrome (often associated with chronic sinusitis, bronchitis, pleuritis, pulmonary fibrosis, bronchiectases)

Blue-red

• Glomus tumor

• Nail bed cyanosis (central circulatory problems, methemoglobinemia)

• Vasculitis

White

• Vitamin/mineral deficiencies (e.g. zinc, calcium etc.)

The discoloration of the nails is usually asymptomatic. Early-stage haematomas and some infections may be uncomfortable.

A biopsy is mandatory when a melanoma is suspected. Where adequate laboratory support is present, histological analysis from a biopsy may help with the diagnosis.

This may be acute, subacute to chronic or relapsing. Most of the colour changes result from chronic disease.

The diagnosis is made on the clinical findings, mycology, bacteriology or histology tests. A key diagnostic factor is whether the whole nail is affected or not and the progression of the colour change. Sometimes targeted questions can help make the diagnosis, e.g. did the discolouration start proximally or distally, slowly or rapidly?

See above causes. Always consider a melanoma in cases of brown/black discolouration.

Treatment is directed at the underlying cause. Routine nail hygiene including clipping and moisturizing may be relevant. In general, patients should be discouraged from excessive manipulation or removal of the cuticle.