Anemia nails vs. normal nails

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Research from 2020 notes that a healthy nail should be:

• shiny
• smooth
• uniform in consistency
• slightly curved

Researchers also note that a healthy nail bed should be pink. The nail bed is the tissue underneath the fingernail or nail plate and is typically flesh-colored. The nail margin — the tip of the nail — should be white.

Anemia may lead to a person developing certain nail irregularities and may cause pale nail beds.

Additionally, a form of the condition — iron deficiency anemia — occurs when a person does not have enough iron in their body. Iron is necessary to make new red blood cells.

This deficiency may cause nail abnormalities such as spoon nails (koilonychia). When a person has spoon nails, the center of the nail becomes sunken, giving a spoon-like appearance. Spoon nails can also be thin and brittle.

A 2022 study states that spoon nails occur in 5.4% of people with an iron deficiency. Researchers also note that iron deficiency is the most common cause of spoon nails in children.

The hemoglobin in red blood cells helps provide color to the skin. Hemoglobin is a protein that carries oxygen inside the red blood cell. If a person has a low red blood cell count, their skin and nails can pale.

Researchers do not fully understand how iron deficiency can cause a person to develop spoon nails. However, they believe it may occur due to reduced iron levels in iron-containing enzymes in epithelial cells — a type of cell that covers the inside and outside skin surfaces of the body.

The nail bed epithelium lies between the nail bed and the nail plate. It allows the nail plate to grow over the nail bed while remaining attached.

Additionally, researchers believe that weakening the connective tissue under the nail plate due to poor blood flow may cause spoon nails.

Spoon nails due to anemia may result from mechanical pressure on thin and brittle nails.

The NHLBI notes that anemia has various causes, such as:

• aging
• blood loss
• family history of anemia
• drinking alcohol in excess
• low levels of nutrients such as:
  • iron
  • folic acid
  • vitamin B12
• health conditions such as:
  • chronic kidney disease
  • cancer
  • inflammation from infection
  • autoimmune conditions

Treating anemia helps treat the symptoms that affect the nails.

Anemia treatments may include lifestyle changes and specific medical treatments or procedures.

Dietary

If someone has iron deficiency anemia, they can increase their iron intake to reduce their symptoms. A person can do this in the following ways:

• taking iron supplements
• eating meat and animal products
• eating beans, leafy greens, and fortified grain products
• eating citrus fruits and vitamin C-rich food sources to increase iron absorption

Spoon nails due to iron deficiency anemia usually resolve within 4–6 months of iron repletion.

Medications and procedures

Other treatments for anemia include:

• medications to encourage the production of red blood cells
• medications to suppress the immune system if an autoimmune condition causes anemia
• blood transfusion
• bone marrow transplant
• surgery if the cause is internal bleeding

According to the American Academy of Dermatology (AAD), a person can keep their nails healthy by:

• keeping nails clean and dry
• cutting nails straight across
• filing with an emery board to remove snags
• not biting fingernails
• not removing the cuticle
• trimming toenails frequently
• not using nails as tools
• avoiding digging out ingrown toenails
• soaking feet in warm salty water if toenails are hard to cut
• wearing shoes that fit properly
• wearing flip-flops at the pool and in public showers

Below are some common questions about nails and anemia.

What do fingernails look like with anemia?

If a person has anemia, their nails may be pale or spoon-shaped.

What is the color of the nail in anemia?

Anemia can cause a person’s nail bed to become pale.

What do vitamin deficiency nails look like?

Different vitamin deficiencies can lead to various nail irregularities. Low iron levels can cause spoon-shaped nails. A lack of vitamin B12 can cause a person to develop blue-black nails.

Does anemia damage the nails?

Although anemia can cause nail abnormalities, these symptoms can resolve with treatment for anemia.

Anemia occurs due to a lack of red blood vessels. It can cause a person to develop pale or spoon-shaped nails.

Nail irregularities that occur due to anemia can resolve once a person receives treatment for anemia.

If a person is experiencing symptoms of anemia or notices any unusual nail changes, they should speak with a doctor.