4.2.5 Nail Colour Changes

Grading & Level of Importance: B

Review:
2022

Revised by J. White, V. del Marmol, Brussels 

Overview:

ICD-11

None.

Synonyms

Not available.

Definition

Abnormal colours (e.g. black, brown, green, yellow, blue-red, white) in nail plate or nail bed.

Aetiology & Pathogenesis

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

 

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)

 

White

  • Deficiency in certain minerals or vitamins. The deficiencies most commonly include zinc and calcium

Signs & Symptoms

Usually asymptomatic discolouration of nails.

Localisation

Finger- or toe-nails.

Classification

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).

Dermatopathology

Depends on cause of discoloration.

Course

Acute, sub-acute to chronic, relapsing.

Complications

Depending on cause, often nail destruction.

Diagnosis

Clinical findings, mycology, bacteriology, histology.

Differential diagnosis

See above.

Prevention & Therapy

Directed at underlying cause.

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