Nail Colour Changes

ICD-11

EE1Z

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.

4.2.5 Nail Colour Changes