Nail Discoloration - Green, Blue, Black, White or Yellow, Why ? (2024)

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Nail Discoloration - Green, Blue, Black, White or Yellow, Why ? (1)By Dr. Liji Thomas, MDReviewed by Afsaneh Khetrapal, BSc

Nails are often referred to as a window on the body’s state of health or disease. They manifest with a variety of changes in shape and growth, due to systemic conditions which affect their normal growth.

Green Nails

Also known as chloronychia, green nail syndrome is the result of a fungal nail infection. The color may range from bluish-gray to dark green. Seen on either fingernails or toenails, the color is in the nail bed rather than on the nail plate, and so persists even after cleaning the nail. It usually affects one or two nails. It may be associated with paronychia.

The cause of the syndrome is a bacterial infection by Pseudomonas aeruginosa, which produces the green pigments pyocyanin and pyoverdin. It is picked up from wet environments, including a bath sponge or loofah, and the bathroom sink. The risk factors include working in a damp environment, and sustaining nail injury which lifts off the nail.

Blue Nails

Bluish-purple peripheral cyanosis of the nails can occur in any condition which interferes with sufficient provision of oxygenated blood to the fingertips. Such conditions include hypothermia, congestive heart failure, disease of the peripheral vessels and cold exposure, all of which lead to a fall in the blood supply to the extremities.

An azure-blue color of the lunula is associated with quinacrine treatment, Wilson’s disease and silver toxicity.

Black Nails

Melanonychia is the term for blackish-brown discoloration of the nails. It is often seen as a normal association with a dark complexion. However, it is also seen with lichen planus. It could additionally indicate a subungual melanoma, or nevus, as well as an adverse effect of some drugs such as psoralens, phenytoin, sulfonamides and antimalarial drugs. Other conditions include malnutrition, thyroid disorders, smoking and hemochromatosis.

Trauma could cause a subungual hematoma to form, which leads to blackish discoloration of the nail bed.

White Nails

Also called leukonychia, white nails are seen in many settings. The causes can be classified as:

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  • True leukonychia due to disease of the nail matrix
  • Apparent leukonychia caused by disease of the nail bed
  • Pseudo-leukonychia caused by conditions that affect the nail plate, such as onychomycosis

Specific variants include:

  • Mees lines: Most often caused by arsenic poisoning, they consist of narrow white lines running transversely across the nails. They may be single or multiple. They persist on blanching. Aside from arsenic toxicity, they may be caused by antimony poisoning, Hodgkin’s disease, mycobacterial diseases, herpes zoster and renal failure, among other conditions.
  • Muehrcke’s lines: These consist of a double white transverse line that appears in hypoalbuminemic states, when the serum albumin level falls below 2g/dL, and vanishes when it normalizes. Thus they may be seen in kidney conditions such as nephrotic syndrome or glomerulonephritis, as well as in hepatic disease, and malnutrition. Chemotherapy may also bring it about.
  • Lindsay’s nails (half and half nail): This refers to apparent leukonychia. The nail has a normally pink half proximally but the distal part is brownish. It is specific for uremic kidney failure.
  • Terry’s nails are associated with congestive heart failure, hepatic failure, and peripheral vascular disease. Other conditions include:
      • Malnutrition
      • Hyperthyroidism
      • Diabetes mellitus in adulthood
      • Hemodialysis
      • HIV
      • Peripheral vascular disease.

Yellow Nails

Yellow nail syndrome is seen mostly in adults but occasionally occurs in children. The nails are thickened and yellowish-green. The lunula is no longer visible. The nail is excessively curved both transversely and longitudinally, and the cuticle is lost. This condition is associated with respiratory difficulty in pleural effusion, and with lymphedema.

Again, liver disease which results in jaundice may lead to yellow discoloration of the nails. Nicotine also stains the nails, which is a tell-tale sign of heavy smoking. Other conditions which produce yellow nails include:

  • Bronchiectasis
  • Rheumatoid arthritis
  • Nephrotic syndrome
  • Sinusitis
  • Tuberculosis
  • Raynaud’s disease
  • Immunodeficiency

References

Further Reading

  • All Nails Content
  • Beau’s Lines
  • Types of Nail Disease
  • Bacterial Nail Infections
  • Median Nail Dystrophy

More...

Last Updated: Feb 27, 2019

Nail Discoloration - Green, Blue, Black, White or Yellow, Why ? (3)

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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Nail Discoloration - Green, Blue, Black, White or Yellow, Why ? (2024)

FAQs

Why is my nail blue and green? ›

Green nail syndrome (GNS) is an infection of the nails that leads to a greenish discoloration of nails, also known as chloronychia. The green discoloration varies from blue-green to dark green to bluish-grey. Since the discoloration is underneath the nail, it will not disappear with washing or scrubbing.

Why is my nail green and black? ›

Green nail syndrome (chromonychia) is a nail disorder characterized by onycholysis and green-black discoloration of the nail bed. This condition is often associated with chronic paronychia. Pseudomonas aeruginosa is the most commonly identified organism in cultures from the affected area.

What do liver failure nails look like? ›

Terry's nails is a type of nail discoloration. The nailbeds look “washed out,” except for a thin reddish-brown strip near the tip. Often, Terry's nails is a symptom of a chronic condition, such as liver failure or diabetes.

Why is my nail turning blue black? ›

Blue or purple nail beds or nails are a common sign of cyanosis, which is caused by a lack of oxygen in the blood. This type of discoloration can also occur on other parts of the body including the hands, fingertips, toes, nose, lips, and tongue.

What do B12 deficiency nails look like? ›

2 Nail changes in vitamin B12 deficiency present as hyperpigmentation of nails like bluish discoloration of nails, blue-black pigmentation with dark longitudinal streaks, and longitudinal and reticulate darkened streaks. The nail pigmentation associated with B12 deficiency is more frequent in patients with dark skin.

What do kidney disease nails look like? ›

Nail changes.

People who have advanced kidney disease can develop: A white color on the upper part of one or more nails and a normal to reddish brown color below, as shown here (half-and-half nails) Pale nails. White bands running across one or more nails (Muehrcke's nails)

What deficiency causes nail discoloration? ›

Research has shown vitamin B12 deficiency to cause brown-gray nail discoloration. White nails can be the result of anemia and pink or red nails may suggest malnutrition with several nutrient and vitamin deficiencies.

What happens if you leave a green nail untreated? ›

Some people get more than one infection, or the infection comes back after treatment (chronic paronychia). Untreated, the infection can cause damage to the nail. Rarely, untreated paronychia can go deeper into the finger or toe and lead to a serious infection.

Is green nail bacterial or fungal? ›

The etiology of a green nail cannot be determined by the clinical presentation alone. It is most commonly caused by a Pseudomonas species, a bacterial organism. However, it can also occur as a result of a fungal organism such as a Candida species or the presence of both bacterial and fungal organisms.

What do nails look like with heart problems? ›

Changes in nail shape and texture

Iron deficiency or overproduction may cause the nail bed's center to look like it had been scooped out, a condition known as spoon nails. Cardiovascular, pulmonary and gastrointestinal problems may also appear in the nails as curves around an enlarged fingertip, known as clubbing.

What does vitamin D deficiency look like in nails? ›

Hapalonychia (soft nails) has been associated with deficiencies of vitamins A and D among other causes. Longitudinal melanonychia of the nail plate has been reported in vitamin D deficiency.

What do iron deficiency nails look like? ›

Koilonychia is an abnormal shape of the fingernail. The nail has raised ridges and is thin and curved inward. This disorder is associated with iron deficiency anemia. Leukonychia is white streaks or spots on the nails often due to drugs or disease.

What does stage 1 nail melanoma look like? ›

The most common symptom of subungual melanoma is a discolored line that appears on your nail. It's usually brown or black and runs from top to bottom (vertical). In some cases, the line can be irregularly shaped and increase in length and width over time.

What are COVID nails? ›

COVID nails are a possible symptom that may occur and persist weeks or months after COVID-19 infection, but what do COVID nails look like? Those changes may consist of dents, orange, red, or white discoloration, ridges, or Beau's lines—horizontal grooves across your nails.

How do you treat a black and blue fingernail? ›

If the hematoma is small and doesn't cause pain, then you can take care of it at home with rest, ice, and pain medication. But if you have a large hematoma, a lot of pain, or any additional injuries — you should seek medical care for drainage and additional treatment.

Why did my blue nail polish turn green? ›

The color change in nail polish is primarily due to a special type of pigment called thermochromic pigment. This pigment is sensitive to temperature variations, causing it to alter its color when exposed to different temperatures.

Will my green nail go away on its own? ›

To stop the infection, keep your nails clean and dry at all times. Avoid soaking the nail and wear gloves when doing chores or work that involves prolonged contact with water. Unfortunately, you will need to wait for greenies to grow out - and frankly speaking - that can take several weeks.

How do you treat a blue fingernail? ›

A doctor may perform a procedure called nail trephination to drain the blood from under the nail. This can help to relieve pain and pressure. The doctor will make a small hole in the nail with a laser or needle. Afterward, the area may be wrapped with a bandage and may continue to drain for up to 3 days.

Should I be concerned if my nails are blue? ›

Blue nails may indicate that the blood is not carrying enough oxygen to the fingertips. There are many possible causes, including heart and lung diseases. Anyone with blue nails should seek medical advice. In some cases, fingernails turn blue or purplish because of cyanosis, which can also affect the lips and skin.

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