What Your Nails Can Tell a Dermatologist

Our nails have the important job of protecting the tips of our fingers and toes, but they can also tell an important story regarding our health. Although most nail changes are only cosmetic annoyances, certain changes offer clues about infection, skin disease, or systemic issues. So if you’re noticing a difference in the color or texture of your nails or a new sore spot, it’s worth knowing what’s causing it, and potentially seeing a dermatologist to rule out anything serious. 

What your nails say about your health

Nails are made of keratin, a protein that also makes skin and hair. Normal, healthy nails should be shiny, smooth, and uniform in consistency — not cracked, pitted, or broken. They should also be translucent, with a pink nail bed underneath that indicates healthy blood flow. 

Nails that don’t fit this “normal” description don’t always indicate illness or disease, but they can sometimes signify an underlying condition. According to the International Journal of Women’s Dermatology, nail disorders are the chief complaint in 10% of all medical visits to dermatology specialists in the U.S., with symptoms ranging from discoloration to texture changes, breakage, thickening, and more. In many patients, the issues are cosmetically induced, such as after wearing nail polish for too long or filing the nails too low. But in others, nail changes serve as a warning sign.

Nail changes that could be a red flag

When examining the nails, dermatologists look for changes including:

Nail discoloration. Changes to the color of the nails can indicate conditions that range from mild to severe in nature. For instance:

• Yellow nails could be from certain medications, nicotine use, a fungal infection, or psoriasis. But it could also be a warning sign of a thyroid disorder or chronic lung disease.

• White nails can happen when people have too little iron in their blood (also known as anemia), which can be treated with iron supplements. White nails with a dark pink band near the tip, however, could indicate liver disease or heart failure. 

• A blue tint in the nails can sometimes result from cold temperatures, but nails that stay blue often signify that the body is not getting enough oxygen – and that lung or heart problems could be present.

• A black streak under the nail can happen from trauma, such as slamming a finger in the car door. But a new or changing dark streak under the nail could be melanoma, the most dangerous form of skin cancer. 

Nail thickening. Nails naturally become thicker with age as cell turnover slows down and dead nail cells pile up, so thick toenails don’t necessarily mean there’s a problem. But in younger people whose toenails start to thicken, something else could be going on, such as:

• Psoriasis, which causes rapid cell buildup and inflammation around the nail matrix. Approximately 40% of people with psoriasis have nail psoriasis, which causes thickening, pitting, and discoloration of the nails.   

• A fungal infection. When fungus gets under the nails, it triggers a defensive inflammatory response in the nail bed, forcing the tissue under the cuticle to produce excess keratin cells that pile up.

• Injury. Runners, dancers, and soccer players in particular are likely to have thick toenails because when toes constantly bump up against the end of the shoe, it damages the nail matrix. This disrupts the cells' ability to flatten out keratin properly, causing the body to produce stacked, excess layers of the protein. 

Ingrown nails. When the edge of the nail grows into surrounding skin, it can become very painful. The most common causes of this is cutting the nail too short or wearing tight shoes, and it doesn’t always sound an alarm. But in some patients with compromised immune systems, an ingrown toenail needs to be treated promptly to prevent health complications. Examples include:

• Those with diabetes. Not only are they more likely to have ingrown toenails due to poor circulation; if the nail gets infected, it can compromise their health. 

• Congestive heart failure. Because CHF is often accompanied by poor circulation, a minor break in the skin from an ingrown nail can quickly escalate into a serious or non-healing ulcer. 

Brittle nails. Fungal nail infections cause brittle nails because fungus breaks down keratin, which gives nails their strength. In addition, brittle nails could result from:

• Systemic medical conditions like psoriasis and eczema.

• Hypothyroidism

• Nutritional deficiencies such as low iron, zinc, protein, or certain B vitamins.

Nail lifting from the nail bed. The nail plate can separate from the nail bed either at the edge of the nail and down toward the cuticle, or it can lift in the cuticle area and up toward the end of the nail. This can make the nail’s shape irregular, the color white or opaque, and the texture pitted or thicker than usual. Nail lifting can happen due to:

• Trauma, such as from wearing ill-fitting shoes, aggressive pedicure treatments, or excessive exposure to moisture.

• Chemicals in nail polish and polish remover.

• Fungal infections.

• Skin conditions such as dermatitis or psoriasis.

• Health conditions such as thyroid problems and diabetes, as well as mineral deficiencies.

• Medications such as chemotherapy drugs and antibiotics.

All of the above. Nails that are discolored as well as thick, brittle, and lifting from the nail bed are most often diagnosed as a fungal infection called Onychomychosis, which accounts for 50% of all nail disorders. It’s usually caused by fungus, but yeasts and molds can also be responsible. Having sweaty feet or athlete’s feet can lead to the condition, and so can walking barefoot in public locker rooms. Senior citizens as well as those with diabetes are at an increased risk. 

Why it’s important to see a dermatologist who can treat nail problems

Nail changes may not seem like a big deal, but it’s best to play it safe if you notice red flags. An experienced dermatologist at Forefront will be able to identify any cause for concern and create a treatment plan that makes the most sense. Whether it’s an antibiotic to cure an infection, a biopsy to rule out skin cancer, or getting a jump on a systemic diagnosis, having a trusted doctor on your side will help you get back on your feet faster and prevent further problems. Contact a Forefront location near you to make an appointment.