What can you do about yellow nails?

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Your nails can tell you a lot about your overall health. Discoloration, weakness and lifted nails all point to various illnesses that may be a result of the change in both your fingernails and toenails. But is all yellowing necessarily a medical condition that requires you to consult your physician? No. So, what causes your nails to change shape and color?

Nail Polish

Certain color shades and frequent use of nail polish and acetone nail polish removers can cause a white-yellow staining of the nail plate. This is purely cosmetic, very common and not harmful.

Treatment: There is no treatment because the staining resolves on its own with time. To speed up the process, give your nails a break from use of polish, avoid acetone nail polish removers and soak your nails in diluted hydrogen peroxide (1part peroxide, 3 parts water) to help reduce the yellowing.

Prevention: Darker shades are more likely to leave the staining, so go with a lighter shade and consider a protective base coat first.

Fungal infections/onychomycosis

Yellowing of the nail can indicate a fungal infection of the nail, more commonly seen in toenails than fingernails. The discoloration becomes worse with tight-fitting shoes or trauma to the nail plates and can be associated with athlete’s foot, as well. The most common fungal infection is from the Trichophyton family. Infection with fungus can lead to thickening and deformity of the nail plate, which leads to the discoloration of the nail.

Treatment: Avoid moist environments and wear comfortable, properly fitted shoes. Treat any underlying fungal infection with an antifungal medication. Antifungals come in both topical and oral form, with the oral being more effective than topical alone. Because nails grow slowly, a systemic medication would need to be prescribed for three to six months in order to fully eradicate. However, cure rates with current antifungals are generally 50-60%, so you might need to repeat the course and still not have the infection fully treated.

Prevention: Your dermatologist can culture your nails to determine the exact type of fungus and tailor the treatment according to what would work best in fighting the underlying fungus.

Onycholysis

Onycholysis occurs when the end of the nail plate away from the attachment begins to lift off the nail bed and looks white or yellow because the nail bed is now exposed to air. This detachment means that the nail plate is no longer sticking to the nail bed. Common causes include trauma, psoriasis, and as a side effect of certain medications. Onycholysis is commonly seen in certain occupations in which people work with their hands (butchers, food handlers and hairdressers/manicurists are common examples).

Treatment: Avoid trauma to your nails, wear protective gloves, and avoid wet/moist environments and harsh chemicals to hands. Also, keep your nails trimmed neatly and avoid cleaning under the nails, as this can worsen the onycholysis and cause it to move further back on the nail bed.

Prevention: If you’re taking medication that may cause or worsen the symptoms, consider discontinuing if the onycholysis becomes bothersome or painful.

Psoriasis

In addition to onycholysis, nail changes with psoriasis can include yellowing of the nails, thickening of the nails and pitting of the nails.

Treatment: The best way to minimize trauma to the nail, systemic meds can help with underlying nail involvement. This is a condition where a dermatologist can really help guide appropriate treatment. A dermatologist can prescribe the most effective and appropriate treatment option. If psoriasis is limited to nails only, you can have steroid injections to the nails (intralesional kenalog injections). However, if there’s diffuse skin involvement and/or psoriatic arthritis along with the nails, a systemic medication is needed. Some of the newer biologic agents, such as Humira, Cosentyx and Taltz, can be helpful with widespread skin and nail involvement. This is where your dermatologist can target therapies depending on severity of the condition.

Yellow nail syndrome

Yellow nail syndrome is a rare systemic disease characterized by yellow toenails and fingernails, along with systemic symptoms, including respiratory breathing problems and lymphedema swelling of the legs.

Treatment: Treatment is mainly focused on compression to help with the lymphedema swelling and to treat the respiratory symptoms. Oral vitamin E has been used for the nails with mixed results.

Self-tanners

Applying a self-tanner can lead to staining of the fingernails.

Treatment: Wear gloves when applying the self-tanner and be sure to wash your hands after application.

Thyroid diseases

Onycholysis can be seen in hyperthyroidism, in addition to yellowing of the nail plates. Nail changes are more visible in hypothyroidism, with the most common changes including thickening and crumbling of the nail along with brittleness and slow growth.

Treatment: Treating the underlying thyroid disease, such as thyroid hormone replacement.

Diabetes

Diabetics often struggle with dry skin, particularly on the legs, along with circulatory issues. Nails can become thickened, discolored, brittle and crumble easily. These nails are susceptible to fungal infections (onychomycosis), which leads to further thickening and yellowing of the nails.

Treatment: Maintaining better glucose/sugar control is important to reduce the chance of diabetes flares. Consider treating underlying fungal infection and take care of your nails in conjunction with podiatry.

Liver diseases

You can see yellowing of skin and nails with underlying liver disease and jaundice with treatment aimed at treating underlying liver disease.

There are a number of causes that can lead to yellowing of the nails. See a dermatologist to help determine the cause and treatment.

Susan Massick is a dermatologist at The Ohio State University Wexner Medical Center.