Black Discoloration Of Nails

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Aspergillus

Bullous disorders

Jaundice

'Old' haematoma (green-yellow) Pseudomonas aeruginosa (Figure 7.20) Red/purple Angioma

Cirsoid aneurysm tumour

Glomus tumour (see Figures 3.8, 5.25)

Congestive cardiac failure (lunula) (Figure 7.21)

Enchodroma

Heparin (transverse)

Lichen planus

Linear red line

Darier's disease

Benign tumours or cysts near proximal matrix Lupus erythematosus Porphyria (with fluorescent light) Rheumatoid arthritis Warfarin

2 Treatment for subungual melanoma may lead to overtreatment of a benign lesion and thus to unnecessary surgery. Excision biopsy is therefore crucial.

Potassium permanganate was often used in the past as a disinfectant for hand and foot baths. Brown staining of the skin and nails was regularly observed. Whereas the stained horny layer soon desquamated, the nails remained dirty brown owing to deposition of manganium dioxide on the nail surface. This can be easily removed by reducing manganium dioxide with ascorbic acid: a small gauze pad is moistened with ascorbic acid solution and used to vigorously wipe the nail surface.

Silver nitrate stains the nail jet-black. The stained nail grows out with a contour parallel to the border of the proximal nail fold. Histopathology has shown black silver nitrate globules penetrating approximately the superficial third of the nail plate; this is the reason that it cannot be easily removed with ammonium compounds.

OTHER DISCOLORATIONS

The varieties of colour change that may occur in the nail apparatus (other than white and brown-black) are listed in Table 7.4, and some examples are shown in Figures 7.17-7.21. Many are due to obvious cosmetic procedures, topical or oral drugs, application of antiseptics (Figure 7.17) or common diseases. None of them is of any particular significance, their presence sometimes aiding in the diagnosis of disease or pointing towards overdose of drugs.

Greenish-black discoloration is typical of Pseudomonas aeruginosa infection (Figure 7.20). It often starts at one side of a finger nail, growing out from under the proximal nail fold. A slight thickening of the latter and breaks in the cuticle may accompany the condition. Treatment is difficult since part of the infection is hidden and not amenable to topical treatment. Even though the condition is harmless for the patient it may cause life-threatening infections in immunocompromised persons. Nurses with this Pseudomonas infection should not work in operation room facilities or with immunocompromised patients.

Pseudomonas Nail Infection

Figure 7.17

Stain due to copper in antiseptic solution.

Figure 7.17

Stain due to copper in antiseptic solution.

Green Nails Discolored

Figure 7.18

Yellow nail syndrome.

Figure 7.18

Yellow nail syndrome.

Black Nail Discoloration

Figure 7.19

Nail discoloration due to systemic antimalarial treatment.

Figure 7.19

Nail discoloration due to systemic antimalarial treatment.

Nail Discoloration Black

Figure 7.20

Pseudomonas colonization of onycholysis leaving nail plate pyocyanin stain.

Figure 7.20

Pseudomonas colonization of onycholysis leaving nail plate pyocyanin stain.

Red lunulae may be seen in particularly severe, acute nail involvement in erythema multiforme, Stevens-Johnson syndrome, Lyell's syndrome, generalized psoriasis, alopecia areata, systemic lupus erythematosus, dermatomyositis and rheumatoid arthritis, among other conditions (Figure 7.21).

Dermatomyositis Nails

Figure 7.21

Red lunulae—occasionally seen in heart failure and alopecia areata.

Figure 7.21

Red lunulae—occasionally seen in heart failure and alopecia areata.

FURTHER READING Melanonychia

Baran R, Haneke E (1984) Diagnostik undTherapie der streifenformigen Nagelpigmentierung, Hautarzt 35:359-365.

Baran R, Kechijian P (1989) Longitudinal melanonychia (melanonychia striata): diagnosis and management, J Am Acad Dermatol 21:1165-1175.

Other discoloration Daniel CR (1985) Nail pigmentation abnormalities, Dermatol Clin 3:431-443.

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Responses

  • Arcangela Palerma
    Is antimalarial drug causes black longitudinal line in nail?
    4 years ago
  • carola
    Can arthiritis cause black nails?
    9 months ago

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