Dr. Jeffrey Lauber

Dr. Jeffrey Lauber

Nails don’t talk, hut they do reveal a lot about: a persons lifestyle and grooming habits. And, if you know what to look for, they also reveal signs of poor health. Many nail abnormalities stem from pigmentation (color) changes in the nail plate. These changes can be caused by internal disease, skin conditions, medications, and external influences such as smoking.

The shape of the pigmentation change is the most revealing clue as to what’s causing the abnormal coloring. Internal disease usually causes pigmentation changes that are moon-shaped like the lunula, while external causes usually result in U-shaped pigment changes. While at first these shapes may be hard to discern, they will become readily apparent as the nail grows out.

Most commonly, internal color changes are caused by prescription medications. For example, medications for bladder infections can turn the nail plate a light brown; testacy cline-based acne medications can turn the nail plate a blue-gray color; and certain cancer medications will turn nail plates blue. Arsenic poisoning, once common in the United States, can leave horizontal white bands across all 20 nails (known as Mee’s lines). Melanoma, a form of skin cancer, can cause pigment changes on the nail plate and nail fold.

The most common external cause of pigmentation changes is tobacco, which stains nails yellow-brown. Cof­fee, burnt sugar, dirt, and shoe polish are other common culprits. Nails can be stained green by exposure to copper sulfate or the familiar pseudomonas bacteria infection. And some fade creams contain hydroquinone, a bleaching agent that can leave nails orange-brown.

To narrow down the cause of the color change, examine the client’s nails in a well-lit area. Look at all 20 nails to determine the extent of the problem and to rule out external causes. (It’s doubtful a client would have shoe pol­ish stains on her fingernails and toe­ nails.) Her fingers and toes should be relaxed and not pressed against any surface. Sometimes, illuminating the nail bed by pressing a small penlight under the fingertip helps detect growths that are in the fingertip. This illumination technique is cheap, quick, and simple (and it will impress even the most sophisticated client).

As with any other nail disorder, clients with unusual color changes on the nail plate that can’t be explained by medications or external causes should be referred to a dermatologist.



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