Chromonychia L60.8 L60.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Change of the nail colour; Colour change of the nails; Nail discoloration

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Discoloration of the nails (nail surface, nail plate and/or subungual tissue).

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  • Grey or grey-blue nail coloration:
    • Argyrie (slate grey; rare today)
    • Phenolphthalein
    • metastatic malignant melanoma
    • Mercury chloride.
  • Red or red-blue nail colouring:
  • Blue or blue-brown (diffuse) nail colouring:
    • Blue discoloration in combination of cardiac vitium and cyanotic flail fingers and toes
    • Medicines: Minocycline, Mepacrin, Chloroquine, Doxyrubicin
    • Systemic diseases: M. Wilson.
  • Green or green-black nail colouring:
    • Pseudomonas infections (green discoloration due to the fluorescent dye of the pathogens, pyoverdin)
    • Mould infection (see Tinea unguium below).
  • Yellow or yellow-brown nail colouring:
  • Orange nail color:
    • After application of nail polish
    • Carrot Icterus ( Aurantiasis cutis)
    • After working with azo dyes.
  • Brown or brown-black nail colouring:
    • narrow or broad band longitudinal linear
    • Bounded centrally or laterally (never embedded in the nail matrix in stripes (check at the free end of the nail)
    • Older nail hematoma.
  • Diffuse homogeneous nail coloration:
    • M. Addison
    • Older nail hematoma: colour mostly deep black (especially on the big toe nail)
    • Medicines (cyclophosphamide; chlorpromazine)
    • Large malignant melanoma or large melanocytic nevus
    • In combination with onychogrypose and polyneuropathy in elderly people
    • Working materials (e.g. photo developer).
  • White discolorations (see below Leukonychie).

Clinical features
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  • Colour anomalies depend on the nail bed, the transparency and adherence of the nail.
  • Cause for a nail discoloration can be:
    • Overproduction of melanin (longitudinal or complete brown or black discoloration) (see below for an overview of melanonychia)
    • Formation of coloured new formations of the nail bed (e.g. glomus tumour).
    • Colour deposits (homogeneously large-area, circumscribed, striped lengthwise or crosswise) in the nail bed and/or the nail matrix e.g.:
    • Surface discolorations (e.g. chemicals, most frequently by coloured nail varnish); a preferential discoloration of the proximal nail wall can be caused by professional substances (e.g. potassium permanganate) or external agents (e.g. in smokers). A discoloration of the distal lunula border indicates an internal disease.
  • White discoloration of the nails represents a polyätiological colour change of the nail plate (see below leukonychia).

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Since nails also contain melanin, their pigmentation level corresponds to their ethnic origin. The darker the skin, the darker the nails. Multiple dark stripes are widespread in dark-skinned Africans, in white Europeans they are to be distinguished with regard to their dignity (see below Melanonychia striata longitudinalis).

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  1. Haneke E (2013) Nail diseases. dermatologist 54: 519-532
  2. Hengge UE et al (2009) Green nails. New Engl J Med 360: 1125
  3. Roh M et al (2007) A case of chromonychia with hyperbilirubinemia. J Eur Acad Dermatol Venereol 21: 127-128


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020