4.2.5 Nail Colour Changes
Grading & Level of Importance: B
Abnormal colours (e.g. black, brown, green, yellow, blue-red, white) in nail plate or nail bed.
Aetiology & Pathogenesis
Vary according to colour.
- 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
- Lichen planus
- Pseudomonas aeruginosa
- Yellow nail syndrome (often associated with chronic sinusitis, bronchitis, pleuritis, pulmonary fibrosis, bronchiectases)
- Glomus tumor
- Nail bed cyanosis (central circulatory problems, methemoglobinemia)
- Deficiency in certain minerals or vitamins. The deficiencies most commonly include zinc and calcium
Signs & Symptoms
Usually asymptomatic discolouration of nails.
Finger- or toe-nails.
No specific classification.
Laboratory & other workups
Depends on suspected underlying disease. Consider clipping of nail for microbial analysis. Histology may be required in brown/black discoloration (mandatory if melanoma suspected).
Depends on cause of discoloration.
Acute, sub-acute to chronic, relapsing.
Depending on cause, often nail destruction.
Clinical findings, mycology, bacteriology, histology.
Prevention & Therapy
Directed at underlying cause.
- S. Gurcharan, H, Nayeem Sadath, A. Uday: Nail changes and disorders among the elderly (2005)
- A. Waldman, C. Schmults: Cutaneous Squamous Cell Carcinoma (2019)
- M. Ramos-e-Silva, M.C. Azevedo-e-Silva, S.C. Carneriro: Hair, nail, and pigment changes in major systemic disease (2008)
- S.K.T. Que, F.O. Zwald, C.D. Schmults: Cutaneous squamous cell carcinoma: Incidence, risk factors, diagnosis, and staging (2018)
- V. Parekh, J.T. Seykora: Cutaneous Squamous Cell Carcinoma (2017)
- R. Gutzmer, S. Wiegand, O. Kölbl, et al.: Actinic Keratosis and Cutaneous Squamous Cell Carcinoma (2019)
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