Nails

Key messages

• Our nails often reflect our general state of health. Changes such as discoloration or thickening can signal health problems, including liver and kidney disease, heart and lung conditions, anemia, and diabetes.

• Changes in color, shape, and/or thickness, swelling of the skin around the nails, bleeding or discharge, and pain could signal nail problems.

• If you are experiencing any nail problems, make an appointment to see a board-certified dermatologist. Dermatologists are the experts in the diagnosis and treatment of nail problems.

  • To find a board-certified dermatologist, visit aad.org/findaderm.

Supporting messages

Bridge to these messages by using phrases like: “It’s important to know,” “I want to emphasize,” “Many may not know,” “Let me share what I’ve been seeing.” Build off these messages by leveraging your expertise about this topic.

• Nail problems make up about one-tenth of all dermatologic conditions and typically increase throughout life, affecting a higher number of older adults. (1-3)

  • Nail problems are more common in those with diabetes or poor circulation. At the first sign of a problem, see a board-certified dermatologist. (4,5)

• Fungal infections cause about half of all nail disorders. (6,7) They are more common in toenails because the toes are confined in a warm, moist, weight-bearing environment. (8)

• Melanoma, the deadliest form of skin cancer, can grow under the nail in rare cases. (9) These types of melanomas may be mistaken for injuries, so consult a board-certified dermatologist if a dark-colored streak appears within your nail plate, if nail discoloration does not gradually improve or if the size of the discolored area increases over time. (10-12)

  • While anyone can develop melanoma on their nails, it’s more common in older individuals and people with skin of color. (13,14)

  • Nail melanoma is often diagnosed at a more advanced stage than melanoma on the skin, making it more dangerous for your health. (15,16)

• Do not try to treat ingrown toenails yourself, especially if they are infected. Instead, make an appointment to see a board-certified dermatologist.

Nail salon safety

• While most nail salons follow strict sanitation guidelines (17), consumers should check to make sure that the salon, manicure stations, footbaths and tools are clean, and that the technicians wash their hands between clients.(18,19) Consumers who get frequent manicures and pedicures should bring their own tools to the salon.

• Don’t let a nail technician cut or push back your cuticle. It may allow an infection to develop.

• Do not wear artificial nails to cover up nail problems, as this may make those problems worse. Artificial nails are not recommended for people prone to fungal infections or brittle nails. People with healthy nails may wear artificial nails, but they should not be worn continuously.

• Don’t shave your lower legs for at least 24 hours before you get a pedicure. If you nick yourself while shaving, a pedicure could put you at risk for an infection.

• If you experience itching, burning or any type of allergic reaction to a nail cosmetic, see a board-certified dermatologist.

Related Academy resources

References

1. Cashman MW, Sloan SB. Nutrition and nail disease. Clin Dermatol. Jul-Aug 2010;28(4):420-5. doi:10.1016/j.clindermatol.2010.03.037

2. Abdullah L, Abbas O. Common nail changes and disorders in older people: Diagnosis and management. Can Fam Physician. Feb 2011;57(2):173-81.

3. Satasia M, Sutaria AH. Nail Whispers Revealing Dermatological and Systemic Secrets: An Analysis of Nail Disorders Associated With Diverse Dermatological and Systemic Conditions. Cureus. Sep 2023;15(9):e45007. doi:10.7759/cureus.45007

4. Vural S, Bostanci S, Kocyigit P, Caliskan D, Baskal N, Aydin N. Risk Factors and Frequency of Ingrown Nails in Adult Diabetic Patients. J Foot Ankle Surg. Mar-Apr 2018;57(2):289-295. doi:10.1053/j.jfas.2017.10.006

5. Yesudian PD, Nwabudike LC, de Berker D. Nail changes in diabetes. Clin Exp Dermatol. Jan 2022;47(1):9-15. doi:10.1111/ced.14859

6. Ghannoum MA, Hajjeh RA, Scher R, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol. Oct 2000;43(4):641-8. doi:10.1067/mjd.2000.107754

7. Wollina U, Nenoff P, Haroske G, Haenssle HA. The Diagnosis and Treatment of Nail Disorders. Dtsch Arztebl Int. Jul 25 2016;113(29-30):509-18. doi:10.3238/arztebl.2016.0509

8. Tan JS, Joseph WS. Common fungal infections of the feet in patients with diabetes mellitus. Drugs Aging. 2004;21(2):101-12. doi:10.2165/00002512-200421020-00003

9. Mole RJ, MacKenzie DN. Subungual Melanoma. StatPearls. StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.; 2024.

10. Kovich OI, Soldano AC. Clinical pathologic correlations for diagnosis and treatment of nail disorders. Dermatol Ther. Jan-Feb 2007;20(1):11-6. doi:10.1111/j.1529-8019.2007.00107.x

11. Piraccini BM, Dika E, Fanti PA. Tips for diagnosis and treatment of nail pigmentation with practical algorithm. Dermatologic clinics. 2015;33(2):185-195.

12. Alani A, Blasdale C, Oliphant T, Hackett C, Langtry JAA. The causes of nail apparatus pigmentation presenting to a melanoma screening clinic a prospective study. Clinical and Experimental Dermatology. 2019;44(6):625-630. doi:10.1111/ced.13897

13. Abdullah L, Abbas O. Common nail changes and disorders in older people: Diagnosis and management. Canadian Family Physician. 2011;57(2):173-181.

14. Robinson MT. Melanoma and People of Color: The Role of Physical Therapists. Rehabilitation Oncology. 2024;42(3):130-137.

15. Darmawan C, Ohn J, Mun JH, et al. Diagnosis and treatment of nail melanoma: a review of the clinicopathologic, dermoscopic, and genetic characteristics. Journal of the European Academy of Dermatology and Venereology. 2022;36(5):651-660.

16. Di Chiacchio N, Hirata SH, Enokihara MY, Michalany NS, Fabbrocini G, Tosti A. Dermatologists' accuracy in early diagnosis of melanoma of the nail matrix. Archives of Dermatology. 2010;146(4):382-387.

17. Safety O, Administration H. Stay healthy and safe while giving manicures and pedicures. 2012.

18. Stout JE, Gadkowski LB, Rath S, Alspaugh JA, Miller MB, Cox GM. Pedicure-associated rapidly growing mycobacterial infection: an endemic disease. Clin Infect Dis. Oct 2011;53(8):787-92. doi:10.1093/cid/cir539

19. Chang RM, Hare AQ, Rich P. Treating cosmetically induced nail problems. Dermatol Ther. Jan-Feb 2007;20(1):54-9. doi:10.1111/j.1529-8019.2007.00111.x

Last updated: 12/04/24