Nail Dystrophy

Nail dystrophy is deformation, thickening or discoloration of your fingernails or toenails. It’s common and can happen for many reasons, including fungal infections, skin conditions and chronic diseases. Also known as dystrophic nails, it’s often a source of pain or embarrassment, but many of the potential causes are treatable.

What nail dystrophy looks like

Nail dystrophy can take many forms. It can affect one nail at a time, multiple nails or all of your nails (on both fingers and toes). Some of the most common forms include:

• Clubbing: This is when your fingernails bulge upward and have a more dome-like appearance because the nail bed underneath is thicker.
• Cracking or splitting: Your nails might crack at the ends or have longer cracks running lengthwise up them.
• Darkening: Your nails can look darker if there’s bleeding or tissue changes underneath them.
• Lightening: Your nails can turn whiter or lighter from some conditions or effects.
• Lines, grooves or ridges: Your nails might look like they have bends, folds or raised sections. They can also be color lines, like Beau’s lines or Mees’ lines.
• Nail lifting or separation: The ends of your nails may lift up and away from the tips of the fingers or toes they’re growing on.
• Pitting: Tiny pit-like dents may form on the surface of your nails.
• Racket nails: Also spelled “racquet,” this makes your nails much wider than expected. The nails on your thumbs and big toes are the most likely to show this.
• Spoon nails: This is when you have spoon- or bowl-like dips on your nail surface.
• Thinning or brittleness: This can happen when something disrupts how your nails grow.
• Yellowing: Several diseases can make your nails take on a yellowish tinge.

Dystrophic nail causes

Physical trauma is the leading cause of nail dystrophy. Fungal infections cause about half of all nail dystrophy cases. But nail dystrophy can happen because of many other conditions. They include:

• Autoimmune diseases, like alopecia areata, lupus and psoriasis, or inflammatory conditions, like lichen planus
• Chronic infectious diseases, like tuberculosis or syphilis
• Circulatory issues, like Raynaud’s syndrome, or conditions that cause low blood oxygen, like heart disease or cystic fibrosis
• Genetic diseases, like pachyonychia congenita or Darier disease
• Growths and tumors, including benign ones, like exostosis and fibromas, or malignant cancers, like subungual melanoma or squamous cell carcinoma
• Malnutrition conditions, like low calcium, zinc deficiency or low vitamin B3
• Medications, especially chemotherapy drugs
• Organ damage or failure, like severe liver scarring (cirrhosis) and kidney failure
• Protein-related diseases, like amyloidosis or systemic conditions, like thyroid diseases and hypopituitarism
• Toxic conditions, like too much iron or arsenic poisoning
• Trauma and injuries, especially if you have trouble feeling your feet due to diabetes-related neuropathy

Diagnosing the underlying condition causing nail dystrophy may involve tests, especially a biopsy. Your provider can tell you more about the suspected causes and what tests might help with diagnosis.

Risk factors

Many risk factors can increase your risk of having nail dystrophy. One of the biggest is your age. That’s because the odds of developing a condition that causes nail dystrophy naturally go up as your age does, especially after age 60. If you’re concerned about other risk factors, talk to a healthcare provider. They can help you understand the risks relevant to your case.

How is nail dystrophy treated?

The treatments for nail dystrophy vary widely and mainly depend on the underlying cause. Treatments can range from medications to nail surgeries (which aren’t common) and more. Your healthcare provider is the best person to tell you about treatment options for your case.

When should I see my healthcare provider?

Your nails are an important indicator of your overall health. If you notice changes to any of your fingernails or toenails, make an appointment with a healthcare provider. Check all of your nails regularly for:

• Changes in nail color, such as spots or streaks, or color changes in the tissue underneath a nail
• Nail shape changes, like curving or separating from the skin underneath
• Nail texture changes, like thickening, thinning, or becoming crumbly or brittle
• Pain, soreness or skin changes around or under your nail

People often seek medical care if their nail dystrophy is painful or if they’re embarrassed about how the changes look. Some changes you may want to ask about include:

• What’s causing my nail dystrophy?
• What are the treatment options?
• Do the treatments have any side effects and, if so, what can I do about them?
• Is my nail dystrophy reversible or will it go away?
• Is there anything I can or should do to help my nails, especially their appearance?

What can I expect if I have nail dystrophy?

What you can expect from nail dystrophy depends on what’s causing it. Many of the causes, especially the most common ones, aren’t dangerous. But they can still be unpleasant or embarrassing. If you’re worried about your nail appearance and what to expect from it, talk to a healthcare provider. They can offer support and reassurance.

Can nail dystrophy be prevented?

Some types of nail dystrophy are preventable, but many happen for reasons you can’t predict or control. Your healthcare provider can tell you more about which forms of nail dystrophy are preventable for you and how you can reduce your risk.