Nail Dystrophy Symptoms: A Complete Guide to Nail Problems

Nail dystrophy refers to any abnormality in the appearance or structure of your fingernails or toenails. It’s not a disease in and of itself, but rather a sign that something else is going on in your body. Think of it like a fever – the fever isn’t the problem, it’s a symptom of an underlying infection or illness.

There are many potential causes of nail dystrophy. Sometimes it’s due to something simple like trauma to the nail, such as stubbing your toe or hitting your finger. Other times, it can be a sign of inflammation, a skin condition (dermatosis), or even a systemic disease. Infections, genetics, and even certain medications can also play a role.

Because there are so many possibilities, getting an accurate diagnosis is key. Your doctor will need to consider a range of potential causes – a differential diagnosis – to figure out what’s really behind your nail dystrophy symptoms. Once they pinpoint the underlying issue, they can develop an effective treatment plan to address the root of the problem and get your nails back to their healthy state.

Common symptoms of nail dystrophy

Nail dystrophy has a wide range of signs and symptoms. If you notice changes to your fingernails or toenails, it’s worth getting them checked out by a doctor or dermatologist.

Changes in nail color

• Yellowing: Yellow nail syndrome is a condition associated with lymphedema (swelling) and respiratory problems. Yellow nails can also be a sign of a fungal infection or other health issue.
• White discoloration (leukonychia): White spots on the nails can be caused by a minor injury. In rare cases, a person can be born with total leukonychia, a hereditary condition that causes the entire nail to be white.
• Darkening of the nail (melanonychia): Dark lines or bands on the nail can be a sign of nail matrix nevi (a benign mole in the nail matrix) or melanoma. Hutchinson’s sign, when the pigment extends to the skin around the nail, is a sign of melanoma.

Changes in nail texture and shape

• Thickening (onychauxis): Nails can thicken due to trauma, fungal infection, or psoriasis.
• Thinning (onychatrophy): Thinning nails may be related to lichen planus or other skin conditions.
• Nail pitting: Small depressions or pits in the nail are a common sign of psoriasis.
• Beau’s lines: Horizontal grooves across the nail can indicate a temporary interruption in nail growth due to systemic illness, chemotherapy, or severe stress.

Other nail abnormalities

• Nail splitting (onychoschizia): Nails can split when hands are repeatedly wet and dry.
• Nail lifting (onycholysis): The nail can detach from the nail bed due to trauma, psoriasis, thyroid disorders, or certain drugs.
• Paronychia: This is an infection of the tissue around the nail. It can be acute (bacterial) or chronic (fungal, inflammatory).

What causes nail dystrophy?

Nail dystrophy can result from a number of causes, including:

Trauma

Physical injuries to the nailbed or nail matrix (the area where your nails begin to grow) can cause nail dystrophy. An example of this is “turf toe,” which can result in bleeding under the nail.

Repetitive minor injuries can also cause problems. I’ve seen this with people who type a lot, and people who play certain musical instruments.

Nail biting and picking are other ways that people can damage their nails. Habit-tic dystrophy is the name for nail damage caused by repetitive trauma like this.

Infections

Fungal infections, like onychomycosis, can cause nail dystrophy. It’s important for your doctor to rule out other causes of nail problems before diagnosing you with onychomycosis.

Bacterial infections can also cause nail dystrophy, sometimes after a bout of paronychia (an infection around the nail).

Viral infections, such as warts around the nails, can also distort nail growth.

Skin conditions

Skin conditions can affect your nails. For example, psoriatic nail dystrophy is a common sign of psoriasis. If you have psoriatic nail dystrophy, you may notice:

• nail pitting
• onycholysis
• thickening of the skin under the nail

Lichen planus can also affect the nails, causing nail thinning, ridges, and pterygium formation.

Eczema and dermatitis can affect the skin around the nails, leading to nail dystrophy and a condition called trachyonychia.

Systemic diseases

Systemic diseases, such as autoimmune diseases, endocrine disorders, and cardiovascular diseases, can also cause nail dystrophy.

Autoimmune diseases like lupus and rheumatoid arthritis can indirectly affect nail growth and structure, while endocrine disorders like thyroid disease and diabetes can cause brittle nails and slow nail growth. Cardiovascular diseases can lead to nail clubbing.

Specific Nail Dystrophies and Associated Syndromes

Nail dystrophy can show up in a number of different ways. Here are some specific types of nail dystrophy and what to look for:

Yellow Nail Syndrome

The most obvious sign of yellow nail syndrome is yellow nails. Other signs include:

• Slow nail growth
• Thickening of the nails

Yellow nail syndrome is also associated with lymphedema (swelling) and respiratory problems.

Dyskeratosis Congenita

Dyskeratosis congenita is a genetic disorder that affects the nails, skin, and bone marrow. Nail changes include:

• Thinning
• Ridging
• Eventual loss of nails

Pachyonychia Congenita

Pachyonychia congenita is a genetic disorder that affects the nails and skin. With this condition, you may see:

• Thickened nails
• Painful calluses on the soles of the feet
• White patches in the mouth

Nail problems include severe thickening and buildup of skin and debris under the nails.

Median Nail Dystrophy

Median nail dystrophy is an uncommon condition that usually affects the thumb. You might see a split or groove that runs lengthwise down the nail.

This can happen because of trauma or repeated small injuries. Some people get relief from a prescription ointment called tacrolimus.

Habit-Tic Dystrophy

Habit-tic dystrophy is a type of median nail dystrophy that’s caused by self-inflicted damage. This can happen from repeatedly picking or pushing at the cuticle.

Differential Diagnosis and Diagnostic Approaches

If your doctor suspects you have nail dystrophy, they’ll start with a thorough examination. This isn’t just about looking at your nails; they’ll want to check out the surrounding skin and get a sense of your overall health. The goal is to figure out what’s going on, and that means ruling out other possibilities first.

For example, they’ll need to make sure it’s not onychomycosis (a fungal infection) or some other type of nail problem. Trauma to the nail, other infections, and underlying skin conditions can all cause similar symptoms.

To get a clearer picture, your doctor might order some tests, such as:

• Nail clippings for fungal culture or PCR: This helps determine if a fungus is the culprit.
• Nail biopsy: If the diagnosis is unclear, a small piece of the nail can be examined under a microscope, potentially through a nail biopsy.
• Blood tests: These can help rule out systemic diseases that might be affecting your nails.

It’s also important to consider whether any medications you’re taking could be causing the nail changes. Several drugs are known to cause nail dystrophy or onycholysis (separation of the nail from the nail bed), so your doctor will want to review your medication list.

Treatment and Management of Nail Dystrophy

Treating nail dystrophy requires a multi-pronged approach. The first and most important step is identifying and addressing the cause of the nail changes. Here’s a breakdown of potential treatment strategies:

• Address the Underlying Cause: Figuring out what’s causing the nail dystrophy is key. Is it a fungal infection, psoriasis, or something else? Treatment will depend on the underlying condition.
• Fungal Infections: If a fungus is to blame, your doctor might prescribe topical or oral antifungal medications. It’s important to take these as directed and complete the full course of treatment, even if your nails start to look better.
• Psoriasis and Lichen Planus: For these conditions, topical corticosteroids, calcipotriol, or other medications that modulate the immune system might be prescribed to reduce inflammation and improve nail growth.
• Protect Your Nails from Trauma: Keep your nails short and avoid activities that put them under repeated stress. Think of it like protecting a wound – the less trauma, the better it can heal.
• Nail Restoration/Reconstruction: While cosmetic procedures can improve the appearance of your nails, remember that they won’t treat the underlying problem. Think of them as a temporary fix, not a cure.

Frequently Asked Questions

To Conclude

Nail dystrophy is a general term that describes a number of changes that can happen to your fingernails or toenails. These changes can be a sign of an underlying condition, so it’s important to get an accurate diagnosis if you notice something unusual.

If you have nail changes that don’t go away, or if you don’t know why the changes are happening, you should see a doctor. A healthcare professional can evaluate your nails and determine if there’s an underlying cause that needs treatment.

Because nail dystrophy can be a sign of other health problems, changes to your nails can help doctors diagnose skin disorders and diseases that affect your whole body, helping you fix ugly toenails. Don’t ignore changes to your nails. They might be telling you something important about your health.