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12 nail changes a dermatologist should examine

Have you noticed a change to any of your nails lately? A change in color, texture, or shape can be harmless, but it can also be a sign of disease. If you notice any of the following changes to a fingernail or toenail, it's time to see a board-certified dermatologist.

1. 
   
2. Melanoma under nail
   
   Medical name: Acral lentiginous melanoma
   
   Dark streak
   If a fingernail or toenail has a new or changing dark streak, it's time to see a dermatologist for a skin cancer check. That dark streak could be melanoma, the most serious type of skin cancer.
   Not every dark streak is a melanoma, but it's always good to have a dermatologist examine one. Caught early and treated, that may be the only treatment you need.
   
   Allowed to grow, treatment becomes more difficult.
   
3. 
4. Fingernail lifting up
   
   Medical name: Onycholysis
   
   Nail lifting up
   If a nail starts to lift up so that it's no longer completely attached, you'll likely see white discoloration, as shown here. When a nail lifts up, the cause is often:
• A fungal infection
• Psoriasis
• Injury from an aggressive manicure
• Injury form cleaning under your nails with a sharp object

5. A dermatologist should examine any nail that's lifting up. You may need treatment to clear an infection. A dermatologist can also give you some tips that may help the new nail grow out normally.
6. 
   
7. Infection around fingernail
   
   Medical name: Paronychia
   
   Redness and swelling around a nail
   If you have redness and swelling around a nail, you may have an infection. When diagnosed early, you can often treat an infection with soaks and antibiotics. If an open sore forms, you'll need more extensive treatment.
8. 
   
9. Infection under nail
   
   Medical name: Paronychia
   
   Greenish black color
   When bacteria cause a nail infection, the nail can turn greenish black as shown here.
   
   Without treatment, a nail infection tends to worsen. Treatment can get rid of your pain and tenderness and help clear the infection.
10. 10.
    
11. Fingernail with pits
    
    Medical name: Pitting
    
    Pitted nails
    If you have dents in your nails that look like they were made by an icepick, this could be a sign that you have a disease that affects your entire body.
    
    People who have pits in their nails may have:

• Psoriasis
• Atopic dermatitis
• Alopecia areata

12. 12.Seeing a board-certified dermatologist for a diagnosis is important. Dermatologists are the specialists who diagnose and treat these diseases. Treatment can help you feel more comfortable and prevent the disease from worsening.
13. 13.
    
14. 14.Yellow nail syndrome
    
    Medical name: Yellow nail syndrome
    
    Yellow nails
    Wearing red nail polish without a base coat or smoking can turn your nails yellow. If your nails turn yellow, thicken, and seem to stop growing, it could be a sign of something going on inside your body.
    
    Lung disease and rheumatoid arthritis can cause yellow nails. You may also have a serious nail infection, which requires treatment.
15. 15.
    
16. 16.Deep groove in nail
    
    Medical name: Beau lines
    
    Deep grooves (or gaps)
    Lines that run the length of a nail are common and usually nothing to worry about. If you see deep grooves that run the width of your nail like the ones shown in this picture, it means that something slowed (or stopped) your nails from growing for a while.
    
    When something causes your nail(s) to completely stop growing for a while, you may see a gap. If this happens, you'll have a place on your nail(s) that's missing nail. The medical name for this condition is onychomadesis (on-ah-coe-ma-dee-sis).
    
    A fever, injury, chemotherapy, or major stress can cause your nails to grow slowly or stop growing.
    
    If you cannot think of what could may have caused your nails to grow slowly or stop growing, see your dermatologist or primary care doctor. Once you find and get rid of the cause, nails often start growing normally.
17. 
    
18. 18.Thick, overgrown nails
    
    Medical name: Onychogryphosis
    
    Ram's horn nails
    This happens when the nails thicken and overgrow. Some people get Ram's horns because the condition runs in the family.
    
    If you have a disease, such as psoriasis, ichthyosis, or circulation problems, you may also develop Ram's horn nails.
    
    Cutting and treating these nails requires help from a podiatrist or dermatologist.
19. 19.
    
20. 20.Spoon-shaped nails
    
    Medical name: Koilonychia
    
    Thin, spoon-shaped nails
    If you have thin fingernails that dip down in the middle and look like spoons, you may not be getting enough iron. People develop an iron deficiency for many reasons, including:

• Lack of proper nutrition
• A health problem with their stomach or intestines
• Sensitivity to gluten (celiac disease)
• High altitude

21. 21.Getting a proper diagnosis and treatment can help you feel better.
22. 22.
    
23. 23.Washboard nails
    
    Medical name: Onychotillomania
    
    Washboard nails
    If you have grooves and ridges in the center of your thumb that look like the ones shown in this picture, you may have developed a habit of picking at (or pushing back) the cuticles on your thumbnails. Many people are unaware that they do this.
    
    A dermatologist may be able to help you break the habit, allowing healthy nails to grow out.
24. 24.
    
25. 25.Clubbing causes nails to curve down
    
    Medical name: Clubbing
    
    Curved nails
    The curving can begin so gradually that many people are unaware it's happening. As the nails continue to curve downward, fingertips often swell and the nails start to feel spongy when pressed on.
    
    If you notice your fingernails start to curve, it's time to see a board-certified dermatologist. Curved nails can be a harmless trait, which runs in the family. Curved nails can also be a sign that you have a disease in the:

• Lungs
• Heart
• Liver
• Stomach or intestine

26. 26.
27. 27.Color change
    A disease inside your body can cause your nails to change color. Certain color changes can be a warning sign of a specific disease, as the following table shows.

1.Color	1.Disease or other health problem
Blue nails	Not enough oxygen in your bloodstream
White nails	Liver disease, diabetes
Pale nails	Anemia
Half pink, half white nails	Kidney disease
Yellow nails	Lung disease, nail infection
Dusky red half-moons	Could be lupus, heart disease, alopecia areata, arthritis, dermatomyositis
Blue half-moons	Could be sign of poisoning
44

Seeing a change to your nails or the half-moons doesn't always mean that you have a disease.

Still, it's important to see a board-certified dermatologist if you notice any changes. Board-certified dermatologists specialize in diagnosing and treating the skin, hair, and nails. They have the expertise to tell you whether the change is harmless or requires medical testing.

Related AAD resources

• Nail fungus
• What is nail psoriasis, and how can I treat it?
• Atopic dermatitis
• Alopecia areata

Images
Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides: 4,5,7,9,10, and 11

Getty Images: 3, 12

Images from the Journal of the American Academy of Dermatology

• 2: J Am Acad Dermatol. 2014;70(4):748-62.
• 6: J Am Acad Dermatol 2007;57:1-27.
• 8: J Am Acad Dermatol 2015;73:849-55.

References
Braswell MA, Daniel CR, et al. "Beau lines, onychomadesis, and retronychia: A unifying hypothesis." J Am Acad Dermatol 2015; 73:849-55.

Fawcett RS, Hart TM, et al. "Nail abnormalities: Clues to systemic disease." Am Fam Physician. 2004;69(6):1417-24.

Kiaravuthisan MM, Sasseville D, et al. Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy." J Am Acad Dermatol 2007;57:1-27.

Kumar V, Aggarwal S, et al. "Nailing the diagnosis: Koilonychia." Perm J. 2012;16(3): 65.

Ring DS. "Inexpensive solution for habit-tic deformity." Arch Dermatol. 2010;146(11):1222-3.

Schwartz RA, "Clubbing of the nails: Clinical presentation." Medscape. Last accessed 12/21/2017.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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