What Your Fingernails Can Say About Your Health

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What Your Fingernails Can Say About Your Health

Your nails can sometimes hint at what is happening elsewhere in your body. Changes in colour, thickness, shape or surface may point to an infection, a skin condition such as psoriasis, low iron, or, less often, a problem with the lungs, heart, liver or kidneys. Most nail changes, though, are harmless and come from minor knocks, ageing or everyday wear. The useful skill is knowing which changes are normal, which deserve a closer look, and which should be shown to a doctor soon.

This guide walks through eight common nail changes, what each one can mean, and what dermatologists say about them.

What healthy nails look like, and how to check yours

According to the Mayo Clinic, healthy nails are smooth, evenly coloured and free of pits, grooves and spots. The pale half-moon at the base (the lunula) varies a lot between people and fingers, so its size alone means little.

A quick self-check takes a minute. In good daylight, look at each nail with polish removed and ask:

  • Is the colour even, or are there streaks, spots or bands?
  • Is the surface smooth, ridged, dented or flaking?
  • Has the shape changed, curving up like a spoon or down over a swollen fingertip?
  • Is the skin around the nail red, swollen or sore?
  • Is this new? Gradual changes over months matter more than a mark you have always had.

Two harmless findings worry people more than they should: fine vertical ridges, which become more visible with age, and small white spots or lines, which are usually from minor injury and grow out with the nail.

1. Colour changes

Colour is the change most people notice first. The American Academy of Dermatology (AAD) links several patterns with possible causes:

  • Greenish-black: often a bacterial infection (commonly Pseudomonas), which tends to worsen without treatment.
  • Blue or bluish: low oxygen in the blood, which can come from lung or heart problems. Sudden blue nails with breathlessness need urgent care.
  • Pale: may go along with anaemia.
  • Yellow: often a fungal infection or nail polish staining; sometimes linked with lung disease.
  • Mostly white, with a darker band at the tip: known as Terry’s nails, first described by Richard Terry in 1954. They are most strongly linked with liver cirrhosis, and also seen with heart failure, kidney failure, diabetes and in older age.
  • Half white, half pink or brown: sometimes seen with kidney disease.
  • A dark stripe running lengthwise: usually harmless, especially in people with darker skin, but a new or changing dark streak should always be checked because it can be a sign of melanoma under the nail.

Tiny red or brown lines under the nail, called splinter haemorrhages, are most often caused by minor injury. In someone who is unwell with fever, they can rarely be a sign of infection of the heart valves, which is why doctors look for them.

2–4. Thick, split and brittle nails

2. Thickened nails

Nails that become thick, rough and yellowish are most commonly affected by fungal infection (onychomycosis), especially toenails. Thickening can also follow psoriasis, repeated pressure from shoes, or poor circulation. Very thick, curved, overgrown nails (sometimes called ram’s horn nails) can run in families and usually need a podiatrist or dermatologist to trim and treat them. When a nail also lifts away from its bed, the AAD lists fungal infection, psoriasis and aggressive manicures among the usual causes.

3. Splitting and peeling

Nails that peel in layers are very common and usually come from repeated wetting and drying: washing up, frequent hand washing, cleaning products and nail polish remover. Poor nutrition can play a part, but in well-fed people it is rarely the main cause. If splitting comes with pitting or the nail lifting, psoriasis is worth considering.

4. Dry, brittle nails

Brittleness increases with age and with exposure to water and chemicals. An underactive thyroid can make nails brittle, and fungal infections can make them crumbly. Because a fingernail takes around six months to grow out fully, and a toenail much longer, any treatment takes time to show.

5–6. Spoon nails and clubbed nails

5. Spoon-shaped nails (koilonychia)

Thin nails that dip in the middle, sometimes enough to hold a drop of water, are classically linked with iron deficiency. The AAD notes that the low iron itself may come from diet, problems absorbing nutrients, coeliac disease or even life at high altitude. Spoon nails are also occasionally seen with haemochromatosis (iron overload), and in young children they can be normal and outgrown.

6. Clubbed nails

In clubbing, the fingertips become wider and spongy and the nails curve down around them. It develops slowly and is painless. Clubbing can be inherited and harmless, but it is also a long-recognised sign of lung disease (including lung cancer and pulmonary fibrosis), some heart conditions, inflammatory bowel disease and liver cirrhosis. Physicians have noted it since Hippocrates, which is why it is sometimes called “Hippocratic fingers”.

A simple home check, called Schamroth’s window test, is to press the nails of matching fingers on both hands together, back to back. Normally a small diamond-shaped gap appears between them. If the gap has disappeared, mention it to your doctor.

Clubbed nails

7–8. Pits and ridges

7. Pitted nails

Small dents scattered across the nail surface are one of the hallmark signs of nail psoriasis. Nail changes are common in people with psoriasis and even more so in those with psoriatic arthritis. Pitting can also occur with eczema (atopic dermatitis) and alopecia areata, an autoimmune condition that causes patchy hair loss. A dent from a one-off knock grows out; pits from a skin condition keep appearing.

Pitted nails

8. Ridges and grooves

Direction matters here. Vertical ridges running from cuticle to tip are usually a normal part of ageing. Horizontal grooves across the nail, called Beau’s lines, show that nail growth slowed or paused for a while. Common triggers are a high fever, serious illness, chemotherapy, injury or major stress. Because nails grow steadily, you can roughly date the event by how far the groove has moved from the cuticle. Ridges on the thumbs in a washboard pattern often come from a habit of picking or pushing back the cuticles.

When to see a doctor

A single nail change is rarely a diagnosis on its own. Doctors read it alongside your other symptoms, history and, if needed, tests. Talk to a doctor or dermatologist if you notice:

  • a new or changing dark streak, or a dark mark that spreads to the skin around the nail;
  • a nail lifting off, bleeding, or redness, swelling and pain around it;
  • a change in shape, such as spooning or clubbing;
  • pitting, thickening or discolouration that does not grow out;
  • nail changes together with symptoms such as breathlessness, tiredness, weight loss or swelling.

Do not try to treat suspected infections or psoriasis with home remedies for months on end. A proper diagnosis, sometimes from a clipping sent to a lab, saves time and gets the right treatment started.

Everyday care for healthier nails

  • Keep nails clean and dry, and wear cotton-lined rubber gloves for washing up and cleaning.
  • Trim straight across, then round the tips gently.
  • Moisturise nails and cuticles whenever you moisturise your hands.
  • Leave cuticles in place: they protect against infection. Clip hangnails rather than pulling them.
  • Limit nail polish remover, and choose acetone-free types.
  • Use licensed salons with sterilised tools.
  • Ask a doctor or pharmacist before taking supplements such as biotin for brittle nails, since biotin can interfere with some blood tests.

Your nails are not a crystal ball, but they are an easy window to check. Notice changes, do not panic about the harmless ones, and get the persistent or unusual ones looked at.

Sources: American Academy of Dermatology: nail changes a dermatologist should examine; Mayo Clinic: fingernails, do's and don'ts; Wikipedia: Terry's nails; Wikipedia: Nail clubbing.

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