Updated: Aug 13, 2018
Toenails are common areas of trauma. They also provide an opportunistic environment for organisms to invade and infect the nails and surrounding toe region. The color of your toenail, alone, can often tell you what is causing the changes in your nails. Check out the list below to learn what can be causing your nails to change color.
A subungual hematoma is an accumulation of blood underneath the nail. This usually occurs from one of two methods: either repeated trauma of the toenails against the ends of shoes (i.e. running) or something falls on your toe.
The discoloration can often resolve on its own after several months. If the toe becomes infected or is painful from added pressure build-up under the nail, the nail can either be punctured to release the pressure or the entire nail can be removed. Both should be performed by a physician in a clean environment. If the discoloration is not due to running or another trauma, it should be evaluated by a healthcare professional for further work-up to rule out a melanoma or another cause.
Nail fungus (aka onychomycosis) is a very common infection of the nails. Fungus is all over in the environment, but it tends to flourish in dark, warm, moist environments. So, when nails get traumatized and lift up off the nail bed, the fungus finds its way underneath the nail and thrives. When the nails become infected, it can make them thickened, misshapened, yellow-discolored, and brittle.
Nail fungus is difficult to treat and even more difficult to prevent it from coming back again. There are topical anti-fungal medications that have a very low success rate, an oral anti-fungal medication (Lamisil) that has the potential for side effects, as well as laser therapy and a nail restoration procedure (Keryflex). There are even home remedies that some of my patients have tried with some success, including Vicks VapoRub and Tea tree oil. The important thing is to treat all the places that may be affected. This means treating athlete’s foot (if you have it), using anti-fungal powder in your shoes, and avoid walking around barefoot, especially in public facilities.
Green nail syndrome (aka chloronychia) is caused by Pseudomonas, which is a bacterium found in wet environments. Toenails can become infected by pseudomonas in a similar way as fungus. When the nails detach from the nail bed, the bacteria can get in underneath. People that work in water, or sweat a lot in their shoes, are at increased risk for developing green nail syndrome.
Any part of the nail that is loose should be cut back until the remaining nail plate is noted to be intact. Topical and oral medications can be used to treat the bacterial infection. The nails should be kept clean and dry to help prevent recurrence (1).
Determining the cause of white nails (aka leukonychia) can be trickier than the others because there are both local factors and system disorders that can result in the nails having partial or complete whitish discoloration. Nail plate injury, different medications, systemic disorders (including liver, kidney, and heart problems), and iron deficiency anemia can all cause whitish discoloration of the nails. Even a specific type of nail fungus can turn the nails white (2). Check out this great article to learn more about the different causes of white nails.
Treatment protocol is based on what is causing the discoloration.
As you can see from above, there can be specific, identifiable causes to nail discoloration. Although some may be more obvious than others, it is always a good idea to have the nail biopsied to determine the underlying cause. That way the nails, and any underlying syndrome, can be treated and managed appropriately.
Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.
1. Chiriac, A., Brzezinski, P., Foia, L., & Marincu, I. (2015). Chloronychia: green nail syndrome caused by Pseudomonas aeruginosa in elderly persons. Clinical interventions in aging, 10, 265.
2. Oakley, A. (Sept 2016). White nail. Retrieved from https://www.dermnetnz.org/topics/white-nail/
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