Common conditions of the nails with illustrated chart

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Common nail problems and their symptoms include the following:

1. Nail psoriasis

According to the National Psoriasis Foundation, approximately 50% of people with psoriasis will also have nail psoriasis. Nail psoriasis can affect a person’s fingernails or toenails.

Symptoms of nail psoriasis include:

• nail pitting, where tiny dents appear in the nail
• white, yellow, or brown discoloration
• crumbling nails
• separation of the nail from the finger or toe
• blood beneath the nail
• nail thickening
• a buildup of debris beneath the nail
• nail ridges
• pain or tenderness

Treatments

A dermatologist can treat nail psoriasis by:

• applying potent corticosteroids to the nail
• applying calcipotriol, a cream used to treat psoriasis
• applying tazarotene, a gel used to treat psoriasis

Nail psoriasis can be challenging to treat and may require more than one type of treatment. If stronger treatments are necessary, a dermatologist may try:

• injecting corticosteroids into or near the nail
• performing laser treatment
• performing PUVA, a therapy that involves exposing nails to UVA rays after soaking them in psoralen
• using medication to treat both skin and nail psoriasis

2. Onychoschizia

Onychoschizia is the medical term for nails that are brittle, splitting, soft, or thin. Onychoschizia is a common nail problem and is more likely to occur in females than in males.

Onychoschizia can occur due to:

• repeated wetting and drying of nails
• low humidity
• frequent use of nail polish and nail polish remover
• extended contact with detergent or cleaning products
• aging
• deficiencies of iron, zinc, or selenium

Treatments

A person can treat onychoschizia by:

• wearing rubber gloves when washing up or using cleaning products
• using less nail polish and nail polish remover
• taking the vitamin biotin
• using moisturizer

3. Onychogryphosis

Onychogryphosis, also called ram’s horn nails, describes when a person’s nail becomes thick and overgrown. Onychogryphosis commonly occurs on the big toe of older adults.

Causes of onychogryphosis include:

• genetics
• trauma
• peripheral circulation disorders
• wearing improper footwear
• foot abnormalities
• skin conditions such as psoriasis or ichthyosis

Symptoms of onychogryphosis include:

• thickened nails
• yellow or brown discoloration
• nails that curve abnormally
• pain

Treatments

A person who has onychogryphosis will need to see a dermatologist or podiatrist to cut their nails. Wearing suitable footwear can also help with onychogryphosis.

However, onychogryphosis can reoccur, so nail removal is the only method to treat it permanently.

4. Ingrown toenails

Ingrown toenails occur when the nail starts to grow into the skin of the toe.

Causes of ingrown toenails include:

• cutting toenails too short or at angles
• wearing shoes that are too small
• experiencing nail trauma
• having a family history of ingrown toenails
• having fungal infections

A person with ingrown toenails may experience the following on their toe:

• pain and tenderness
• swelling
• redness
• infection

Treatments

Treatments for ingrown toenails include:

• soaking the foot in warm water
• cutting toenail straight across
• gently massaging the nail
• wearing comfortable shoes
• taking prescribed antibiotics
• having surgery to remove part of the nail

5. Fungal infections

A fungal nail infection occurs when fungus enters a person’s nail, usually via a small crack. Fungal nail infections are more likely to occur on toenails than the fingernails.

Causes of fungal nail infections include:

• nail injury
• diabetes
• a weak immune system
• circulation problems
• athlete’s foot

Symptoms of fungal nail infections include:

• yellow, white, or brown nail
• cracked or fragile nail
• thickened nail

Treatments

Doctors can treat fungal nail infections with antifungal pills or by surgically removing the nail.

6. Onycholysis

Onycholysis is when a person’s nail starts to separate from their skin. There can be many causes of onycholysis, including:

• fungal infection
• psoriasis
• nail injury from aggressive manicure
• iron deficiency
• overactive thyroid
• prolonged immersion in water

Onycholysis can cause white discoloration where the nail has lifted from the skin. If infection occurs, the nail may have green or yellow patches.

Treatments

A person can treat onycholysis by:

• removing the unattached nail
• keeping nails out of water
• using gloves when cleaning
• taking medication to treat any infection
• using a prescribed drying agent, such as 3% thymol, after washing hands

7. Paronychia

Paronychia is an infection at the base of the nail. There are two forms of paronychia:

Acute paronychia

Acute paronychia occurs due to infection of the nail fold, the skin at the base of the nail.

Symptoms of acute paronychia include:

• redness and swelling of the skin at the base of the nail
• pain
• pus from the cuticle
• fever
• pain in the armpit glands

Chronic paronychia

Repeated contact with irritants can cause chronic paronychia. People who constantly have wet hands are more likely to have chronic paronychia. Chronic paronychia often starts on one nail and spreads to others.

Symptoms of chronic paronychia include:

• redness and tenderness at the base of the nail
• white, yellow, or green pus discharge from the cuticle
• distorted, ridged nails
• yellow or green nails
• brittle nails

Treatments

A person can treat acute paronychia by:

• using soaks
• applying antibiotic creams
• taking antibiotic tablets
• lancing any abscesses

Treatment for chronic paronychia includes:

• keeping hands clean and dry
• using gloves when cleaning or working with chemicals
• applying topical creams or lotions
• taking antifungal drugs

8. Punctate leukonychia

When small white spots appear on the nails, it’s called punctate leukonychia. Trauma to the nail, such as knocks or nail-biting, can cause punctate leukonychia.

Treatments

Punctate leukonychia will eventually disappear as the nail grows out.

9. Subungual hematoma

A subungual hematoma is a bruise that appears underneath the nail. Injuring the nail, such as by stubbing a toe or wearing shoes that are too tight, can cause subungual hematomas.

A person with a subungual hematoma may notice:

• pain and tenderness in the nail
• lifting of the nail
• spots of purple, red, brown, or black on the nail

Treatments

A person can treat a subungual hematoma by:

• applying ice wrapped in a cloth or towel to the nail
• compressing the finger or toe with a bandage
• resting
• elevating the injured digit
• taking pain medication

A subungual hematoma should disappear as the nail grows out, which can take 6⁠–9 months.

A person should seek medical attention if their subungual hematoma:

• keeps bleeding continuously
• is incredibly painful
• occurs alongside severe damage to the base of the nail

A doctor may X-ray the nail to check for injury to the bone beneath it.

The doctor may also lance the subungual hematoma if it is causing pressure to build on the nail.

There are many ways a person can keep their nails healthy. To maintain healthy nails, the American Academy of Dermatology (AAD) recommends:

• keeping nails clean and dry
• cutting nails straight across
• using an emery board to remove any snags on the nail
• not biting nails
• not using nails to open cans or as a tool
• cutting nails regularly
• wearing footwear that fits properly
• wearing flip-flops at public pools and showers
• never pulling at hangnails

A person who notices any unusual changes to their nails should talk with a doctor. The doctor can recommend what treatment a person may need for their nail issue.

A person who has received treatment for a nail condition but has no improvement should also talk with their doctor.

There are many conditions that can affect a person’s nails. Treatment for nail conditions will depend on the cause.

A person who is concerned about changes to their nails should speak with their doctor.