The Nitty-Gritty of Nail Disease

“Fungal infection of the nails, onychomycosis, is likely the most common nail condition for which people seek medical attention. A fungal nail is thick, discolored, splits and lifts from the nail bed.”

Nail conditions are similar to many hair disorders in that there are some diagnoses that are made clinically without hesitation. On the other hand there are several nail diseases that do not demonstrate a textbook appearance. In fact, many nail conditions can look similar. A few conditions will be briefly described.

Trauma to the nail can show red-black debris under the nail.  It can also appear as white spots on the nail. In both instances, the dry blood and white spots will grow out with nail growth. Trauma of the nail can also be demonstrated by ridging of the nails.

Some nail changes can suggest internal disease. Many of these findings look very distinct. However, if the nail appearance is subtle, then a traditional examination and laboratory tests will be the primary source of diagnoses. A few examples of conditions that can have a specific nail finding include: liver disease, kidney disease, heart conditions, lung disease, anemia and diabetes.

Psoriasis is a common condition that dermatologists diagnose and treat quite often. A biopsy of the skin is frequently not needed to identify psoriasis. However, if one only has psoriasis of the nail, the diagnosis may be more difficult. Common nail findings of psoriasis are pits, ridges, and nail discoloration, so called oil spots. Nails can separate from the nail bed, split, and crumble. This latter description is similar to other nail conditions. If one is to confirm the diagnosis, a biopsy of the skin under the nail has to be done. Furthermore, once the diagnosis is made, optimal treatment is usually done by injections under the nails or systemic therapy.

Darkly pigmented nails are probably the most alarming abnormal characteristic of nails. Melanoma of the nail usually does not occur on multiple nails. The dark pigmentation often extends to the cuticle region. Trauma is not a precursor. In fact, as stated earlier, the dark discoloration would grow out, but not in the case of melanoma. In skin of color, dark streaks of the nail are a common occurrence. It is often seen in multiple nails (fingernails and toenails), and the streaks can be of varying widths. This condition is known as melanonychia striata. As always, if there is any uncertainty, one must see a dermatologist.

Fungal infection of the nails, onychomycosis, is likely the most common nail condition for which people seek medical attention. A fungal nail is thick, discolored, splits and lifts from the nail bed. This description is very similar to that of psoriasis. A nail clipping can be performed and sent to the lab to confirm a nail fungus. However, results often come back negative despite the clinical appearance. Moreover, treatment can be given solely from the examination and the condition improves. There are several treatment options. Topical nail lacquers can be beneficial; however the time to see any improvement can easily take months up to a year. Oral medications are pretty tried and true, but blood tests are often necessary due to the risk of liver damage. Laser treatment is becoming more popular due to the lack of systemic involvement.

The hallmark of treating nail disease is knowing that it takes time to see a noticeable difference due to the time it takes for new nails to grow out.  Furthermore, conditions due to trauma and genetics often persist indefinitely.


Fair Oaks Podiatry office (located in the same office as Renascance Dermatology) has partnered with Renascance Dermatology and is offering 25% off Laser Nail Treatment for patients of Dr. Dwana Shabazz. Schedule your appointment by calling 703.865.6801. Visit for more information, directions, office hours and insurance questions. Offer expires 10/31/2016.

Dr. Dwana Shabazz received her undergraduate degree at Xavier University of Louisiana and both her medical degree and masters of public health degree at George Washington University. She remained at George Washington University for her internship in Internal Medicine. She then moved to Los Angeles for her Dermatology Residency at King Drew Medical Center/Harbor-UCLA. Dr. Shabazz has been in private practice in the Northern Virginia area since 2006. She opened her own practice, Renascance Dermatology, in 2013. Dr. Shabazz is a Fellow of the American Academy of Dermatology, a Diplomate of the American Board of Dermatology, and a member of the Women’s Dermatologic Society.