Staining of the Nail Plate

Staining of the nail plate is a common cosmetic issue that can occur due to a variety of reasons such as the use of certain medications, medical conditions, and environmental factors. In this article, we will discuss the main definitions and types of nail staining, as well as their causes and treatment options.

Definitions:

1. Nail Plate: The nail plate is the hard, protective covering of the nail that is made up of keratin. It is the part of the nail that we see and that we paint with nail polish.
2. Staining: Staining refers to any discoloration of the nail plate that changes its natural color. The discoloration can range from a yellow or brown hue to a black or blue-black color.

Types of Nail Staining:

1. Surface Staining: Surface staining refers to any discoloration that is on the surface of the nail plate. This type of staining can be caused by the use of dark nail polish or by exposure to certain chemicals. It can usually be removed by using a nail polish remover.
2. Subungual Staining: Subungual staining refers to any discoloration that is located under the nail plate. This type of staining is usually caused by a medical condition or the use of certain medications.
3. True Nail Staining: True nail staining refers to any discoloration that is within the nail plate itself. This type of staining is usually permanent and can only be removed by growing out the affected nail.

Causes

Staining of the nail plate can be caused by a variety of factors, including internal health conditions, external factors, and lifestyle choices. Here are 20 common causes of nail discoloration:

1. Fungal infections: One of the most common causes of nail staining is a fungal infection, also known as onychomycosis. This can cause the nail to become yellow, brown, or black.
2. Melanoma: Melanoma, a type of skin cancer, can also cause nail discoloration. This is often accompanied by other symptoms, such as a dark line or streak on the nail.
3. Psoriasis: Psoriasis is a skin condition that can also affect the nails, causing them to become discolored and thickened.
4. Lichen planus: Lichen planus is a skin condition that can cause white spots or lines on the nails, as well as discoloration and ridges.
5. Alopecia areata: Alopecia areata is an autoimmune disorder that causes hair loss, and it can also cause discoloration and ridging of the nails.
6. Yellow nail syndrome: Yellow nail syndrome is a rare condition that causes the nails to become thick, discolored, and curved.
7. Eczema: Eczema, a skin condition that causes itching and redness, can also cause the nails to become discolored and brittle.
8. Thyroid disease: Thyroid disease, such as hypothyroidism or hyperthyroidism, can cause the nails to become brittle and discolored.
9. Kidney disease: Kidney disease can cause the nails to become pale or yellow, and they may also become thick and brittle.
10. Liver disease: Liver disease, such as cirrhosis or hepatitis, can cause the nails to become yellow and brittle.
11. Anemia: Anemia, a condition where there is a lack of red blood cells, can cause the nails to become pale and brittle.
12. Iron deficiency: Iron deficiency, also known as anemia, can cause the nails to become spoon-shaped and brittle.
13. Diabetes: Diabetes can cause changes in the appearance of the nails, including discoloration, thickening, and ridging.
14. Rheumatoid arthritis: Rheumatoid arthritis, an autoimmune disorder, can cause the nails to become thick, discolored, and ridged.
15. Nail trauma: Trauma to the nails, such as repetitive manicures or using harsh chemicals, can cause staining and other changes in the appearance of the nails.
16. Smoking: Smoking can cause the nails to become yellow and brittle.
17. Exposure to certain chemicals: Exposure to certain chemicals, such as cleaning products or nail polish, can cause discoloration and other changes in the appearance of the nails.
18. Vitamin deficiencies: Vitamin deficiencies, such as a lack of biotin or vitamin C, can cause the nails to become brittle and discolored.
19. Aging: As we age, the nails can become thinner, more brittle, and more prone to staining.
20. Poor hygiene: Poor hygiene, such as not washing your hands regularly or not keeping your nails clean, can cause staining and other changes in the appearance of the nails.

It’s important to note that some medications, such as antimalarials, can also cause changes in the appearance of the nails. Additionally, some medical treatments, such as chemotherapy, can cause the nails to become discolored and brittle

Symptoms

Symptoms and signs of staining of the nail plate.

1. Discoloration: One of the most noticeable symptoms of staining is a change in the color of your nails. The color may range from yellow to brown, black, green, or blue, depending on the underlying cause of the stain.
2. Thicker nails: If the nail plate is infected with a fungus, it may become thicker and more brittle than normal.
3. Brittle nails: Brittle nails are another common sign of nail staining. They may break or chip easily and may be more prone to splitting.
4. Nail separation from the nail bed: When the nails become thick and brittle, they may separate from the nail bed, causing pain and discomfort.
5. Deformed nails: Deformed nails are another common symptom of nail staining. The nails may become misshapen or have ridges or pits on the surface.
6. Foul odor: Fungal infections can cause a foul odor to emit from the nails, which is a clear sign of staining.
7. Pain: Pain is another common symptom of nail staining. The pain may be caused by the thickening and deformation of the nails, as well as separation from the nail bed.
8. Inflammation: Inflammation is another symptom of nail staining, especially if the underlying cause is a fungal infection.
9. Bleeding: Bleeding is another sign of nail staining, especially if the nails are infected with a fungus.
10. Swelling: Swelling is another common symptom of nail staining. The swelling may be accompanied by pain and redness.
11. Itching: Itching is another common symptom of nail staining, especially if the underlying cause is a fungal infection.
12. Peeling: Peeling is another symptom of nail staining. The nails may become thin and start to peel away from the nail bed.
13. Crumbling: Crumbling is another symptom of nail staining. The nails may become fragile and start to crumble, especially at the edges.
14. Slow growth: Slow nail growth is another common symptom of nail staining. The nails may take longer to grow and may be thinner than normal.
15. Ragged edges: Ragged edges are another symptom of nail staining. The nails may become rough and have jagged edges.
16. White spots: White spots are another symptom of nail staining. They may appear on the nails as small, white dots.
17. Pitted nails: Pitted nails are another symptom of nail staining. The nails may have small, shallow pits on the surface.
18. Dark streaks: Dark streaks are another symptom of nail staining. They may appear as dark lines or bands on the nails.
19. Nail ridges: Nail ridges are another symptom of nail staining. The nails may have raised ridges running vertically or horizontally across the surface.
20. Discoloration under the nail: Discoloration under the nail is another symptom of nail staining. The skin under the nails may appear yellow, brown, or black, depending on the underlying cause of the stain.

Diagnosis

There are many types of diagnostic tests and laboratory tests that can be performed to diagnose conditions that can cause staining of the nail plate. Here is a list of 20 such tests:

1. Microscopic examination: A simple and quick test that involves looking at the affected nail under a microscope to check for the presence of fungi, yeast, or other microorganisms that may be causing the staining.
2. KOH preparation: A test in which a small sample of the affected nail is scraped and mixed with potassium hydroxide (KOH) to check for the presence of fungal infections.
3. Culture: A test in which a small sample of the affected nail is taken and cultured in a laboratory to check for the presence of fungal infections.
4. Nail biopsy: A test in which a small sample of the affected nail is taken and examined under a microscope to check for any underlying medical conditions.
5. X-ray: An X-ray can be used to check for any underlying bone or joint conditions that may be causing the staining of the nail plate.
6. Magnetic resonance imaging (MRI): An MRI can be used to check for any underlying medical conditions that may be causing the staining of the nail plate.
7. Computed tomography (CT) scan: A CT scan can be used to check for any underlying medical conditions that may be causing the staining of the nail plate.
8. Blood tests: Blood tests can be performed to check for any underlying medical conditions such as anemia, liver disease, or kidney disease that may be causing the staining of the nail plate.
9. Urine tests: Urine tests can be performed to check for any underlying medical conditions such as kidney disease or urinary tract infections that may be causing the staining of the nail plate.
10. Fungal culture: A fungal culture test can be performed to check for any underlying fungal infections that may be causing the staining of the nail plate.
11. Allergy testing: Allergy testing can be performed to check for any underlying allergies that may be causing the staining of the nail plate.
12. Thyroid function tests: Thyroid function tests can be performed to check for any underlying thyroid conditions that may be causing the staining of the nail plate.
13. Vitamin and mineral tests: Vitamin and mineral tests can be performed to check for any deficiencies that may be causing the staining of the nail plate.
14. Autoimmune disease testing: Autoimmune disease testing can be performed to check for any underlying autoimmune conditions that may be causing the staining of the nail plate.
15. Endocrine testing: Endocrine testing can be performed to check for any underlying endocrine conditions such as diabetes that may be causing the staining of the nail plate.
16. Genetic testing: Genetic testing can be performed to check for any underlying genetic conditions that may be causing the staining of the nail plate.
17. Parasite testing: Parasite testing can be performed to check for any underlying parasite infections that may be causing the staining of the nail plate.
18. Bacterial culture: A bacterial culture test can be performed to check for any underlying bacterial infections that may be causing the staining of the nail plate.
19. PCR testing: PCR (polymerase chain reaction) testing can be performed to check for the presence of any specific microorganisms that may be causing the staining of the nail plate.
20. Nail scraping: A test in which a small sample of the affected nail is scraped and examined under a microscope to check for the presence of any

Treatment

1. Topical antifungals: Topical antifungals are used to treat fungal infections of the nails. These medications are applied directly to the affected nail and surrounding skin. Examples of topical antifungals include terbinafine, amorolfine, and ciclopirox.
2. Systemic antifungals: Systemic antifungals are taken orally and are used to treat more severe or widespread fungal nail infections. These medications include itraconazole, fluconazole, and griseofulvin.
3. Debridement: Debridement is the removal of debris and infected tissue from the nail. This can be done with a surgical blade or other instrument, or through the use of a chemical solution such as urea.
4. Nail removal: In severe cases of fungal nail infection, removal of the entire nail may be necessary. This is typically done under local anesthesia and allows for more effective treatment of the underlying infection.
5. Photodynamic therapy: Photodynamic therapy involves the use of a photosensitizing agent and a light source to destroy the fungal organisms.
6. Laser therapy: Laser therapy uses high-intensity light to destroy fungal organisms and improve the appearance of the affected nail.
7. Topical steroids: Topical steroids can be used to reduce inflammation and itching associated with nail infections.
8. Nail avulsion: Nail avulsion is a procedure in which the entire nail is lifted away from the nail bed to allow for more effective treatment of the underlying infection.
9. Nail bed reconstruction: In cases of severe nail damage, reconstruction of the nail bed may be necessary to promote the growth of a healthy nail.
10. Total nail replacement: Total nail replacement involves the removal of the entire damaged nail and replacement with a synthetic nail.
11. Nail polish: Nail polish can be used to cover and protect the affected nail, and may also contain antifungal agents.
12. Nail wraps: Nail wraps are protective coverings that can be applied to the nail to protect it from further damage.
13. Parenteral antifungals: Parenteral antifungals are medications that are given by injection, and are used to treat severe or widespread fungal nail infections.
14. Home remedies: Some people use home remedies such as vinegar or tea tree oil to treat nail infections, although the effectiveness of these remedies has not been scientifically proven.
15. Dietary changes: Making changes to your diet, such as reducing your intake of sugar and processed foods, may help to improve the health of your nails and reduce the risk of infection.
16. Good hygiene: Practicing good hygiene, such as keeping your nails clean and dry, can help to prevent nail infections.
17. Shoes and socks: Wearing shoes and socks that allow your feet to breathe can help to reduce the risk of fungal nail infections.
18. Avoiding trauma: Avoiding trauma to your nails, such as by wearing gloves when working with harsh chemicals, can help to prevent nail damage and infection.
19. Nail strengthening: Using products that strengthen your nails, such as biotin supplements, can help to improve the overall health of your nails and reduce the risk of infection.
20. Regular nail care: Regular nail care, such as regular trimming and filing, can help to keep your nails healthy and reduce the risk of infection.

References