Nail Discoloration

Aka: Nail Discoloration, Leukonychia, Melanonychia, Chromonychia, White Nails, Yellow Nails, Black Nails, Green Nails, Red Nails, Blue Nails

1. See Also
   1. Fingernail
   2. Nail Abnormality
   3. Transverse Linear Nail Lesion
   4. Nail Longitudinal Striation
   5. Nail Abnormality
2. Definitions: Chromonychia
   1. Color changes of nails
3. Causes: White Nail - Leukonychia (partial or complete)
   1. Congenital (autosomal dominant)
      1. Abnormal keratinization of underlying nail matrix
      2. Results in nail plate white discoloration of one or multiple nails with all or partial nail involvement
      3. No Clinical Significance (normal variant in adults and children)
   2. Terry's Nails (all White Nails)
   3. Half and Half Nails (white proximal, pink/red distal)
   4. Transverse Linear Nail Lesions
      1. Muehrcke's Lines
      2. Mees' Lines
      3. Transverse striate Leukonychia (white lines)
         1. Minor nail matrix or cuticle trauma
   5. Leukonychia punctata (white spots)
      1. Minor trauma to Nail Cuticle or matrix
4. Causes: Miscellaneous Color Changes
   1. Green Nails
      1. Pseudomonas pyocyanea infection
   2. Red Nails
      1. Nail Telangiectasia
      2. Congestive Heart Failure
5. Causes: Blue Nails
   1. Medication Side Effect
      1. Quinacrine
      2. Chloroquine
      3. Minocycline (Minocin)
      4. Doxorubicin (Adriamycin)
      5. Melphalan, Bleomycin, Daunorubicin
   2. Wilson's Disease (Azure lunula)
   3. Ochronosis
   4. Psoriasis
   5. Alopecia Areata
   6. Silver Poisoning (Argyria)
6. Causes: Black Nails (Melanonychia) or dark longitudinal streaks
   1. See Nail Abnormality for other longitudinal striations
   2. Vertical Nail Bands (Longitudinal Melanonychia)
      1. Hyperpigmented bands occur as normal variant in 90% of black patients
      2. Distinguish from Subungual Melanoma (see below)
   3. Medication Side Effects
      1. Cyclophosphamide (Cytoxan)
      2. Excessive Fluoride Supplementation (Fluorosis)
   4. Melanonychia striata
      1. Common in dark skinned persons
      2. Spontaneous or secondary to trauma or Chemotherapy
   5. Benign Nevus
      1. Uniform brown longitudinal streak localized to nail
   6. Subungual Melanoma
   7. Chronic Renal Failure
      1. Distal nail bed discolored brown
7. Causes: Yellow Nails
   1. Yellow Nail Syndrome
   2. Onychomycosis
   3. Psoriasis
   4. Alopecia Areata
   5. Raynaud's Syndrome
   6. Hyperthyroidism
   7. Tetracycline
8. References
   1. Fawcett (2004) Am Fam Physician 69(6):1417-24