Multiple Causes of Black Toenail

Multiple Causes of Black Toenail
By Elizabeth S Durham

Black toenail is a common condition occurring in dark-pigmented individuals and is medically termed as ‘Melanonychia.’ It is due to the presence of melanin in the nail plate. Melanocytes of the nail matrix activate and proliferate unusually in this condition. This proliferation results in the deposition of melanin in the toenail and thus the toenail becomes black. Most commonly, melanonychia occurs as a single longitudinal band which is brown to black in color.

The race of the individual affected plays an important role in determining this condition. Dark colored people are more prone to this condition. Other conditions, such as acquired immunodeficiency syndrome, inflammatory disorders of the nail, drug usage, Addisons disease, pregnancy, and trauma are also predisposing factors for black toenail. Laugier-Huntziker syndrome is an uncommon condition in which pigmented lip or genital macules also appear in addition to melanonychia.

Traumatic melanonychia is a very large category which covers people suffering from black toenail. It can occur in any toe, but usually there is a predilection for the nail of the big toe, fourth and fifth toes. The appearance of traumatic melanonychia is usually different from that of cutaneous melanonychia. In traumatic melanonycia, there is a deposition of deoxygenated coagulated blood beneath the toenail, while in other cases usually melanin is responsible for the discoloration.

Whatever the cause may be, black toenail is a clinical condition which requires a complete workup to the reach a definitive diagnosis. The workup starts with taking an appropriate history in which the cause of the discoloration, timing, appearance, and evolution of the toenail color is noted. If there is a history of trauma, the diagnosis and further workup becomes easy, however, if not, then a further investigation is required. Enquiring about the symptoms of systemic diseases discoloring the nails is also important. In addition, the drug history of the patient may also help.

Once the history is complete, the toenails require a thorough examination. If multiple nails are involved then the chances of a malignancy like melanoma is very rare, however involvement of only one nail is an alarming sign. Further examination to rule out systemic causes of black toenail should also be done.

Laboratory and x-ray findings do contribute in determining the exact cause of black toenail. A biopsy sample taken from the toenail is sent for the histopathology in order to confirm the diagnosis of melanoma of the toe nail.

The treatment of traumatic black toenail is usually basic first aid, while other benign conditions are treated by addressing the cause. However if an early-stage melanoma is diagnosed as the cause of the black toe nail, then it needs to be removed as soon as possible in order to avoid its spread to other body parts.

Elizabeth writes on all types of medical issues from bunions treatment to the treatment of a black toenail.

Her medical practice is in Rockford, IL, USA.

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