Change in nail color: causes, symptoms, diagnosis, treatment

Changing the color of the nail plate (chromonichia) can result from exogenous staining of the nail and can be associated with a number of endogenous factors affecting the color of the nail plate. Select a color change for white, yellow, green, blue, red (purple), brown (black).

Leukonihia (white coloration) is divided into true and apparent. Dysfunction of the nail matrix leads to the development of true leikonihia, and the apparent reflects the state of the microcirculatory bed. White transverse bands or white spots are characteristic for disruption of maturation and keratinization of onychoblast and are found in neurocirculatory dystonia, hypo- and avitaminosis, familial benign papiller of Guzero-Haley-Haley, trauma of the nail. Onychodystrophy should be distinguished from white superficial onychomycosis; in the clinical picture of fungal lesions, surface foci of white color can be combined with striation of the nail.

In addition, apparent leukonichia can be recorded in anemia, liver cirrhosis, chronic kidney failure, nephrotic syndrome, acute poisoning, and shocks of any etiology.

Yellow staining of nails is more common in onychomycosis. A characteristic feature is the discoloration of the affected area of the nail. The yellow color of the entire nail plate can be caused by a number of endogenous and exogenous factors. In particular, with jaundice of any etiology, discoloration of the nail plate may be the earliest manifestation of the disease, along with hysteria of the sclera and mucous membranes. The yellow color of the nails is also characteristic of carotenoderma, can occur when taking a number of medications. The combination of thickening of the nails with yellow staining of the entire surface of the nail plate is diagnosed in chronic lymphostasis (yellow nail syndrome) and in erythrodermia of various genesis. Long-term use of decorative varnishes for nails without first applying a "basic" coating on their surface also leads to yellow staining.

Red (violet) nail coloration (erythronomy) is a reflection of the microcirculation state in this zone. Thus, diffuse reddish bluish staining is characteristic of venous stasis and occurs with heart failure in combination with acrocyanosis and cyanosis of the lips. With insufficient arterial blood circulation in the distal phalanges of the fingers, there is an uneven pinkish-red coloration over the nail of the nail. In addition, erythronychia is characteristic of psoriasis, red flat lichen, secondary amyloidosis, Darje's disease, bullous epidermolysis. In psoriasis, in the case of the subungual papule, there is also onycholysis. Erythronomy can be a sign of neoplasm in the nail bed (hemangioma, glomus tumor, enchondrome, etc.). This symptom is expressed in diseases of the hematopoiesis system, vasculitis and coagulation and hemostasis disorders (for example, hemophilia, thrombocytopenia, anticoagulant intake). Subungual posttraumatic hematoma in the early stages can lead to violet-red staining of the nail.

The brown (black) color of the nail (melanonichia) is caused by a number of induction agents (fungi-dermatophytes, yeast-like fungi, protheus, etc.). Perhaps the exogenous staining of the nail with the use of various external preparations (silver nitrate, dithranol, potassium permanganate), decorative coatings and in contact with tobacco. Often, melanonichia occurs in the face of dark-skinned and dark-skinned people, ie, those belonging to V and VI phototypes, is described in pregnancy. This staining is also characteristic of melanocyte formations in the nail bed region (nevus, melanoma). The initial manifestations of melanoma in the region of the terminal phalanx of the finger are characterized by the involvement of only one finger in the process, the fuzzy borders of the lesion, the beginning from the region of the nail hole, the gradual spread of pigmentation to the peri-oral groove and the fingertip. A distinctive feature of melanonichia in melanoma is the absence of changes in color of the nail as the nail plate grows. Longitudinal melanonichia (longitudinal strip on the nail plate) is a sign of some ethnic characteristics, vitiligo and is described in HIV-infected patients on the background of long-term use of various medications.

The green color of the nail plate can be caused by the evolution of subungual hematoma, occurs in infectious, more often bacterial, processes caused by coccal microflora, Pseudomonas aeruginosa, etc.

Blue (gray) nail coloration is characteristic for patients with argyria, occurs with long-term use of a number of medications, including antimalarial drugs, minocycline, phenothiazides, etc. In dermatological practice, such a change in the color of nails happens when using solutions containing copper sulphate in external therapy.

[1], [2], [3]