Nail Disorders

Nails change for many reasons: an injury or a manicure, psoriasis, eczema or a fungal infection, and sometimes a problem with the thyroid, the lungs or another internal organ. Doctors call these changes onychodystrophies: they are not one disease but a symptom that points to a cause.

The same-looking nail can have very different origins, so a diagnosis is never made from one sign alone. The doctor looks at which part of the nail is affected, how many nails have changed and what is happening with the skin and hair, and only then draws a conclusion.

The dermatology department of the Trichology Institute in Kharkiv sees adults and children. The signs that tell nail disorders apart are set out by Professor Yulia Ovcharenko in her publication "Onychodystrophies: differential diagnostic markers."

When to show your nails to a doctor

Do not put off a visit if:

a dark band or spot appears under a nail with no clear injury, especially on a single nail, or if it is getting wider or darker or the color is spreading onto the skin around it. Show it to a doctor soon, to rule out a malignant process;
one nail keeps getting more deformed, or a growth or bleeding appears under it. Tumors pressing on the nail's growth zone are one possible cause;
your fingertips are getting thicker and the nails are curving like a watch glass. Acquired clubbing is rare and in 80% of cases is linked to lung disease. If you also have a cough or shortness of breath, see a general practitioner first rather than waiting for a dermatology appointment;
grooves appear across all your nails at the same level, or several nails are coming away at the base: this often points to a body-wide cause, such as an illness with fever or a medication;
white bands appear across the nails along with feeling unwell, or you may have been exposed to toxic substances. Bands like these are described in arsenic and thallium poisoning. This is a rare cause, but if you suspect it you need emergency care;
there is pain, swelling, redness or pus around a nail, all the more so if you have diabetes or poor circulation.

Book a routine consultation if:

a nail is lifting, thickening or changing color;
your nails have pits, roughness or ridges, especially along with a rash or hair loss;
your nails break and split in layers despite gentle care;
your nails have become concave, like a spoon, or unusually soft;
you notice nail changes in a child.

Make an appointment

Why nails change

A nail grows out of the matrix, the growth zone at its base, and lies on the nail bed. The look of the change often tells the doctor which part has been hurt. The causes of onychodystrophies vary widely:

External factors. Injuries, poor manicure technique, a habit of picking at the nails, tight heels, frequent hand washing, water, irritants and chemicals, and the demands of some jobs.
Skin diseases. Psoriasis, eczema, lichen planus and also alopecia areata.
Infections. Fungal infection of the nails (onychomycosis), and bacteria under a lifted nail.
Hormonal disorders. Hypothyroidism is among the causes of soft nails, hyperthyroidism among the causes of clubbing. In hypoparathyroidism, Beau's lines appear about three weeks after a tetany attack, as described in the publication "Hormones and hair."
Internal diseases and deficiencies. Lung disease, heart defects, cirrhosis, low blood albumin, severe iron deficiency, systemic sclerosis, exhaustion.
Medications. Chemotherapy in particular. Ultraviolet light, alone or together with tetracycline antibiotics, can make a nail lift.
Inborn conditions and age. Pachyonychia congenita and micronychia; with age, lengthwise ridges and onychogryphosis become more common.

What nail changes look like

Use this as a guide, not as a self-diagnosis tool: almost every sign has several possible causes.

Surface

Grooves across the nail (Beau's lines). The matrix stopped working for a while. Depth shows how severe the damage was, width shows how long it lasted, and several lines mean repeated episodes. On single nails the cause is more often a manicure, an injury, eczema or chronic inflammation of the nail fold; on all nails at the same level, a general illness or medication.
Tiny pits (thimble nails). Psoriasis, alopecia areata, eczema.
Rough, dull "sandpaper" nails (trachyonychia). Alopecia areata, lichen planus, psoriasis, eczema.
Lengthwise ridges and cracks (onychorrhexis). Mild ridges are a common sign of aging. Marked ones occur with lichen planus, poor blood supply, an injury or a tumor.

Shape

Concave spoon nails (koilonychia). In adults they are more often linked to occupation or severe iron deficiency; on children's toes they are normal.
Drumstick fingers, watch-glass nails (clubbing). A sign that calls for looking for a cause in the lungs, heart, liver or thyroid.
A nail like a ram's horn (onychogryphosis). Thick, hard, yellow-brown, most often on the big toe in older people.

Color

Opaque white spots or bands (leukonychia). Most often the result of an injury; they move along as the nail grows.
Yellow-orange patches, the "oil drop" sign. Visible through the plate and seen in psoriasis.

Lifting, thickness, strength

The nail lifts from the bed at the free edge (onycholysis). An injury, psoriasis, onychomycosis, ultraviolet light. There is also an idiopathic form, only on the fingers and with no thickening under the nail, caused by constant contact with water and irritants.
The nail comes away at the base (onychomadesis). Severe damage to the matrix. Several affected fingers point to a general cause.
Thickening with scale under the nail (onychauxis). Psoriasis, onychomycosis, eczema.
Brittle, layering nails (onychoschizia). Dehydration of the plate, often in women, for example from frequent hand washing.
Soft, thin nails (hapalonychia). There are many causes, from an inborn tendency and deficiencies to hypothyroidism and poor manicure technique.
Ingrown nail (onychocryptosis). Inflammation of the nail fold and tissue overgrowth, more often on the toes, tight shoes being one reason.

Diagnosis at the Trichology Institute

Dermatologist consultation. The doctor asks when the changes appeared, what came before them, which medications you take, what conditions you have and whether skin diseases run in your family, and examines your skin as well as your nails. The department is headed by Yulia Kachuk.
Photo records. FotoFinder equipment lets us document nail diseases in photos, so they can be compared over time. More on the Dermatoscopy page.
A dark band under a nail. Show it to a doctor soon, to rule out a malignant process.
Lab tests. The list depends on the suspected cause; see Laboratory diagnostics.

How a doctor tells similar signs apart

Mees' lines or Muehrcke's lines. Both can look like white bands across the nail. Muehrcke's lines fade when pressed, the plate stays clear, and the band does not move as the nail grows, because the change is in the bed itself. Mees' lines are opaque and move out with the nail.
True or false leukonychia. In the first, the plate itself is white; in the second, the bed under it is.
Idiopathic onycholysis or lifting from psoriasis or fungus. The first occurs only on the fingers and with no thickening under the nail.

What comes next: treating the cause

The treatment is aimed not at the nail but at whatever changed it, so the plan depends on the diagnosis. Only a doctor chooses the medication, its form and how long to use it.

What the dermatology department treats

The conditions our department works with include psoriasis, eczema, atopic dermatitis and fungal infections of the skin and nails. Depending on the diagnosis and severity, the doctor prescribes topical treatment and, when indicated, systemic therapy.

When you need another specialist

Often the nail simply shows where to look next. So the doctor may refer you:

to an endocrinologist if a thyroid or parathyroid problem is suspected;
to a general practitioner, a pulmonologist and a cardiologist for clubbing;
to your oncologist if the changes appeared during chemotherapy.

If a nail has grown in, the doctor will advise you what to do.

What not to do on your own

Do not stop prescribed medication, even if you suspect it has changed your nails. Tell the doctor who prescribed it.
Do not start antifungal products without a doctor's diagnosis: they will not help with psoriasis or eczema, and time will be lost.
Do not cut away, remove or pry up a changed nail.

What you can do right now

Less contact with water and irritants, gloves for cleaning, a moisturizing cream for hands and nails, a careful manicure and roomy shoes.

Create a treatment plan

Outlook and follow-up

The outlook depends on the cause. A nail grows slowly and shows the past. Beau's lines and true white bands move toward the free edge as the nail grows, so a band you notice today may tell of something that happened months ago. Healthy nail appears from the base while the old part slowly grows out, so results are judged over months, not weeks.

Inborn conditions and some age-related changes do not go away; here what matters is naming them accurately and ruling out other causes. At follow-up visits the doctor compares photos and adjusts the treatment if needed.

Nails can be part of a wider picture: in alopecia areata, nail changes are read as a sign of a more severe course. In a study by Inessa Serbina of 60 patients, they were found in 19% of those who had lost 25–74% of the hair on the scalp and in 48% of those who had lost 75–100%.

Children are seen by our dermatologists in close cooperation with pediatricians and other specialists.

We see patients by appointment at 17 Danylevskoho St, Kharkiv. Consultation fees are in the price list.

Doctors

Prices

Consultation of a dermatologist / children’s dermatologist 1000 UAH

Frequently Asked Questions

I have a dark band under a nail. Can it wait?

No. You cannot find the cause at home, so show such a band to a doctor soon, to rule out a malignant process. Be especially quick if it is on one nail, appeared with no injury, is getting wider, or the color is spreading onto the skin.

Book a dermatologist consultation and say when you noticed the band and whether it has changed since.

Do white spots on nails mean a lack of calcium?

Most often, no. Small white spots most often come from an injury to the nail's growth zone, for example during a manicure. They move along with the nail and are eventually trimmed off.

Reasons to see a doctor are bands or whitening on many nails at once, or whitening along with feeling generally unwell. Whitening that disappears when pressed is linked to the nail bed, and its cause needs to be found.

What causes grooves across my nails?

These are Beau's lines, one of the most common nail dystrophies. They mean the growth zone stopped working for a while. On a single nail the cause is more often mechanical damage, a manicure, a habit of picking at the nail or inflamed skin at its base.

If the lines run at the same level on all nails, the doctor will look for a general cause: an illness with fever, erythroderma or a medication. Try to recall what happened in the months before the groove appeared: it helps to find the cause.

Why do my nails break and split? Will vitamins help?

Brittleness usually comes from dehydration of the nail: frequent hand washing, water, irritants. The free edge splits into horizontal layers. It is a common problem, more often in women. Vitamins alone do not remove this cause, so limiting contact with water and irritants matters more.

If your nails have also become soft or concave, the doctor may check for iron deficiency or a thyroid problem. Supplements are best taken based on test results.

How can I tell nail fungus from psoriasis?

You can't at home. Both onychomycosis and psoriasis can cause thickening under the nail and lifting of the plate, and thickening also occurs in eczema. Tiny pits, yellow-orange "oil drops" and a rash on the skin can point to psoriasis, but the final diagnosis is the doctor's.

So do not start antifungal products on your own: without a diagnosis they may turn out to be useless while the real cause stays untreated.

My nail has lifted from the bed. What should I do?

Do not cut or pry it up, keep it away from water and irritants, and book a dermatologist. Lifting has several causes: an injury, psoriasis, onychomycosis, ultraviolet light, including together with tetracycline antibiotics, and constant contact with water.

The yellowish-white color comes from air under the nail; green or another shade comes from bacteria or bleeding. If the nail is coming away at the base or several fingers are affected, come sooner, since this can point to a general cause.

Can nails point to diseases of the internal organs?

Yes, although the look of a nail alone does not give a diagnosis. For example, thickened fingertips with curved nails are most often linked to lung disease; whitening of the bed that disappears when pressed, to low albumin or medications; and markedly concave nails, to severe iron deficiency.

If a dermatologist sees such a sign, they will tell you which other specialists and tests your case calls for.

My hair is falling out and my nails have changed. Is it connected?

It may be. Pits and roughness of the nails are typical of alopecia areata, and in this disease they point to a more severe course. Thyroid and parathyroid problems can also affect both hair and nails.

Be sure to tell the doctor about both symptoms. On hormonal causes, read the publication "Hormones and hair."

My child's toenails are concave. Is this dangerous?

In children, spoon-shaped toenails are a normal feature and go away on their own. Bring your child to a doctor if they are on the fingers, do not pass with growth, or come with other skin and nail changes.

Children's nails can change for other reasons too: roughness of several or all nails (so-called twenty-nail dystrophy) can occur in children with no cause found. Our dermatologists see children.

Do manicures harm nails?

Poor manicure technique is among the known causes of soft nails, grooves across the nail and white spots, because the nail's growth zone is sensitive to mechanical damage. Take particular care with the cuticle and the base of the nail.

If your nails have already changed, show them to a doctor first. They will tell you whether to take a break from manicures and whether the changes are actually related to them.

Should I remove my polish before the visit?

Yes, it is best to come without polish or gel polish, at least on the affected nails: the doctor needs to see the color and surface of the plate. If the coating is hard to remove, ask about it when you book.

Bring a list of the medications you take and any earlier test results. Old photos of your nails can help too.

How long until the nail looks normal?

Nails grow slowly, toenails even more so, and a changed area takes months to grow out. Even once the cause is gone, that area stays on the nail until it reaches the free edge. It is the new growth at the base that gets assessed.

Inborn changes may not go away, and in a chronic disease the result depends on its course. A doctor can give you an accurate timeframe only after a diagnosis.