‘Nail melanonychia’ is a term used to discuss with dark pigmentation of the nails, each fingernails, and toenails. In certain people, it’s a physiological feature, nevertheless it will also be the symptom of an underlying health problem.

Particularly, it has been linked to melanoma, bacterial or fungal infections, or other skin diseases. That’s why it’s so essential to research its cause to be able to avoid serious complications. The way to discover it? In the next article, we’ll let you know more about its symptoms, diagnosis, and possible treatments.

What’s nail melanonychia?

Nail melanonychia is a condition of the nails. The nails are convex, semi-transparent structures positioned on the distal a part of the fingers. They’re mainly made up of dead cells containing keratin, a fibrous protein that offers them firmness and resistance.

Physiologically, there’s no melanin within the nails. That is the substance chargeable for skin pigmentation. What happens in nail melanonychia is that melanin causes discoloration of the nails since it’s present within the nails.

It could appear as a single dark band or stripe on the nail surface. In other cases, it spreads throughout the complete structure, causing discoloration throughout the complete piece. Its appearance is normally brown or black. As well as, it could appear on a number of nails.

The symptoms of nail melanonychia

The fundamental clinical manifestation of nail melanonychia is the looks of a brown, black, or grayish longitudinal band. This normally starts on the matrix, but extends towards the tip of the nail plate. In rare cases, it involves the complete nail or originates as a transverse band.

Based on information from Dermatology Research and Practice, the dark coloration is because of a rise within the number and performance of melanocytes. The latter are the cells chargeable for synthesizing melanin.

When the colour is gray, the cause is hyperpigmentation of the epithelium.

It’s possible that the nail also presents several colours and that the lines that make up the nail melanonychia are wide. As well as, if the cause is a malignant tumor, other serious symptoms could also be present, equivalent to the next:

• Nodules
• Ulcerations
• Nail dystrophy
• Involvement of the encompassing skin
• Pain (in rare cases)

Sorts of nail melanonychia

Depending on the discoloration of the nail, several types of nail melanonychia will be distinguished. Let’s have a look:

• First, we discover longitudinal or striated melanonychia. That is probably the most common form. On this case, there is simply a protracted, longitudinal band along the nail.
• The second type is diffuse or total melanonychia. What happens is that the discoloration affects the complete nail plate.
• Finally, it will be transverse. The colour line crosses the nail transversely.

What are its causes?

Nail melanonychia occurs because of an increase within the variety of melanocytes or their activity. That’s, it occurs when there’s a better than normal melanin production.

• A rise within the variety of melanocytes within the nail is known as ‘melanocytic hyperplasia’. This condition will be benign, but in some cases, it also has characteristics of malignancy.
• When it occurs because of increased melanin production, it’s called ‘melanocytic activation’.

Nevertheless, there are various pathologies or situations that may result in nail melanonychia. We’ll explain them in the next sections.

Infections

Certain infections, each fungal and bacterial, can result in nail melanonychia. Some fungi are capable of manufacturing melanin, which is incorporated into the nails. It’s more common on the feet, as they’re subjected to more continuous moisture.

Some bacterial infections, typical of individuals with a weakened immune system, result in this. For instance, Pseudomonas infection. It may even  be observed in individuals with human immunodeficiency virus.

Injuries and skin conditions

Blows to the hands or nails may cause nail melanonychia. The identical is true for various skin diseases. This pathology has been described within the context of psoriasis, lichen planus, or amyloidosis.

Systemic diseases and pregnancy

Certain diseases, equivalent to Addison’s disease or Cushing’s syndrome, can result in this condition. The identical is true for some vitamin deficiencies, equivalent to vitamin B12 deficiency. Malnutrition has also been linked.

Even though it isn’t a disease, pregnancy has been found to be a time when the incidence of nail melanonychia increases. The truth is, on this case, it’s common for several different toes to be affected.

Medications

Some drugs, especially those used for chemotherapy, may cause melanonychia. That is one of the common causes of transverse nail banding.

Tumors

Each benign and malignant tumors may cause nail melanonychia. For instance, squamous cell carcinoma is one kind of cancer that may cause it. The identical is true for acral lentiginous melanoma. This can be a rare, infrequent kind of melanoma that affects the nails.

Lentigo is one other associated benign condition, as is nail matrix nevus. The latter is probably the most common reason for melanonychia in children. It’s characterised by the presence of ‘nests’ of melanocytes. That’s, by accumulations of melanocytes on the affected site.

Risk aspects

Nail melanonychia can occur in people of all ages and races. Nevertheless, it affects African-Americans and Japanese more steadily. A lot in order that its incidence is estimated to be greater than 75% in African Americans and as high as 20% in Asians.

Nevertheless, this condition is rare in Caucasians. The skin types most affected, in line with Fitzpatrick’s classification, are V and VI.

Moreover, age will also be considered a risk factor; it’s particularly seen in people over 50 years of age.

Other associated aspects should do with the work environment. Individuals who work in continuous contact with water or wet substances usually tend to develop nail melanonychia because of infections.

The identical applies to frequent exposure to trauma. Whether at work, during certain sports activities, or every other motion, shocks can result in melanonychia.

The diagnosis and treatment of nail melanonychia

Diagnosis of nail melanonychia will be complex. In some cases, it’s sufficient to investigate the clinical picture and have an obvious trigger, equivalent to a blow. Nevertheless, in lots of other patients, it’s needed to resort to complementary tests to attain a definitive diagnosis.

Essentially the most commonly used test is a biopsy. It consists of extracting a sample of the affected nail and analyzing it within the laboratory. The target is to rule out whether it is a malignant pathology equivalent to melanoma. It’s essential to perform it in cases of sudden onset or a history of melanoma.

The treatment of nail melanonychia will rely on its cause. If it’s a benign process, it is probably going that no intervention can be needed. Nevertheless, if it’s malignant, surgery could also be suggested. The surgery could also be based on removing the nail and even the finger.

What it is best to remember

Nail melanonychia is a pathology that consists of abnormal and dark pigmentation of a number of nails. This condition will be because of multiple causes, each benign and malignant. For instance, it might probably be a symptom of melanoma.

It’s due to this fact essential to at all times seek the advice of a physician within the event of this sign. Early diagnosis can significantly improve the prognosis by allowing early treatment.

It’d interest you…