If you’ve noticed any changes in your finger and toenails recently, your body might be trying to tell you something. A number of nail changes can be harmless, but they can also signal an illness.
Toenails and fingernails are made of a substance called keratin, the protein also found in skin and hair. Nails are a more hardened, pure form of keratin than skin or hair. Finger and toenails grow from the base of the nail bed, with keratin forming in layers. This cell growth generates from what’s called the matrix, which is the base of a nail under the skin. The matrix is constantly producing new keratin and the cells are dead by the time they’re exposed from under our skin, much like hair.
Another component of nails is the cuticle, which is a thin layer of skin that grows at the base of the nail bed and protects the matrix from exposure to germs and foreign substances. At the bottom of your nails, you’ll notice a section that’s lighter in color than the rest. This is called the lunula, so named for its half-moon shape. You may not see lunulas on all of your fingers and toenails, and that’s perfectly fine. They are a part of the matrix, and can be obscured beneath your skin.
With a basic understanding of how nails are supposed to look, it’s not hard to notice when something isn’t right. Healthy nails look clear and smooth, and are free of cracks and discoloration. There are a number of conditions that can cause nails to become unhealthy and they aren’t all as straightforward as you might think. Nail health deterioration can indicate health problems all throughout your body.
Nail discoloration can be more than an unsightly annoyance. If you notice a dark streak or a growing dark spot on your nail, it could be melanoma. Melanoma is a very serious form of skin cancer that can spread quickly to other parts of your body. Early detection and treatment will ensure that it doesn’t have that opportunity. On the other hand, your nail may have undergone trauma resulting in a splinter hemorrhage, which simply means some broken blood vessels beneath the skin and nails. If the line of discoloration is a splinter hemorrhage, it will usually require no treatment.
Paronychia is another condition that can cause your nail to appear black, but usually also appears in a patch with tinges of green rather than a line. This discoloration is usually a sign of infection in the skin beneath the nail. Typically, the skin around your nails becomes inflamed and red in cases of paronychia. If you notice black or dark discoloration in your nails, visiting your dermatologist is highly recommended. Ruling out melanoma and other diseases quickly is important for both your health and your peace of mind.
If your whole fingernail changes color, or if you notice the half-moon shaped lunula changing color independent of the rest of your nail, it can be a warning sign of a number of conditions. For example, blue nails usually imply a lack of oxygen in your bloodstream, which is often a medical emergency. If your nails are turning yellow, it might be due to painting them red without a base coat or an early warning sign of lung disease or rheumatoid arthritis. The fact that discoloration can result from so many different sources, erring on the side of caution is always your best bet. Lunulas turning blue could be a sign of some kind of poisoning, while red half-moons can point to all kinds of ailments ranging from arthritis to lupus and heart disease.
Physical changes to your nails are very obvious and can cause extreme discomfort in some cases. Onycholysis describes the process by which a nail begins to lift up from the skin. Apart from being visibly elevated, the nail may also appear whiter or develop whiter patches where the nail isn’t in contact with skin. This nail deformity is usually caused by a problem within the nail, like a fungal infection or psoriasis. Trauma caused by cleaning under your nails or an improper manicure/pedicure can also cause nails to lift.
Pitting, which looks like the nail has been stabbed or picked at leaving behind dimples, is another physical deformity that should be considered a warning sign. Pitting can be caused by psoriasis or atopic dermatitis. Alopecia areata, a condition that causes hair loss in patches, can also cause pitting.
Onychogryphosis (or “ram's horn” nails) is a condition that causes nails to thicken and grow much faster than normal. This gives them the appearance of horns, and can be caused by conditions like psoriasis or poor circulation. There is also some evidence that the disease is hereditary since people with family members who have had onychogryphosis are more likely to develop it themselves.
If your nails indent or thin in the center, taking on the appearance of a spoon, you may have what's called koilonychia. This condition is usually caused by an iron deficiency, which is itself a symptom of diseases like celiac and other intestinal or stomach ailments.
There are quite a few ways to treat misshapen or discolored nails, but the right treatment depends on the cause of your nail problem.
Treating ailments localized to the fingers (such as infections, fungal or otherwise) is straightforward. Your dermatologist will prescribe antibiotics or antifungals which should clear up issues quickly.
If pitting, discoloration or lifting up occur as a result of psoriasis, alopecia, or other general skin conditions, your doctor will attempt to treat the ailment as a whole. Topical or oral medications are usually prescribed to treat these types of diseases, and they work to relieve symptoms even in your nails.
If your nails are discolored or spoon-shaped due to internal illness or deficiencies, treating the underlying health issue should restore nails to their healthy state. You may be given iron supplements to treat spoon-shaped nails. If celiac disease is to blame for your condition, you should see improvement with a gluten free diet. If a more serious issue such as lung disease or melanoma is to blame, treatment might be more difficult. However, as with any medical issue, the sooner it's detected, the easier it is to treat.
With some of these nail problems, nail loss is possible, but unlikely. In the event that your nail is lost or removed as part of treatment, your dermatologist can recommend ways to encourage healthy regrowth. However, keep in mind that it takes at least half a year for fingernails to regrow completely, and toenails take around a year and a half to come back entirely.
If your nails have changed shape, color, texture, or appearance, a quick diagnosis will save you a lot of trouble. Be cautious and call your New England dermatologist today to make sure your nails aren’t warning you about something worse.