At Livingstone Dermatology, we understand that your skin is a reflection of your health and well-being. We are committed to the latest advancements in dermatological science, and dedicated to providing you with quality care.
Dark lines or discolouration on the nails are something many people notice but often overlook. For most, these marks are harmless. But sometimes, they can point to something deeper. Melanonychia is the medical term for a dark streak, band or diffuse pigmentation of the nail.
It is a relatively common finding, especially in individuals with darker skin tones and can affect one or several nails on the hands or feet. Although most cases are benign, it is important to have any new or changing pigmentation checked by a dermatologist.
A professional assessment helps distinguish between harmless pigmentation and more serious conditions, including rare nail cancers. Beyond health concerns, many people also seek evaluation for cosmetic reassurance or to address an uneven nail appearance that affects confidence or comfort.
Melanonychia itself is not a disease, but rather a symptom or sign of another underlying process. It occurs when melanin is deposited in the nail plate. Normally, the nail grows out clear. But when pigment-producing cells (melanocytes) become active in the nail matrix. Which is the part of the nail that generates new growth, brown or black streaks can appear.
This pigmentation can take several forms:
Dermatologists typically classify the condition into 2 main types based on how the pigment is produced. This includes:
| Melanocytic activation (increased pigment activity) |
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| Melanocytic hyperplasia (increased number of pigment cells) |
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The development of melanonychia can be triggered by a variety of factors. Some are temporary or harmless, while others warrant closer attention.
Some of the common causes include:
Melanonychia can occur on its own, but it is sometimes linked to other skin or systemic conditions. These include:
The condition primarily presents visible colour changes in one or more nails. But some of the other symptoms to look out for are:
In some cases, pain or tenderness, especially if an infection or melanoma develops underneath
There are certain factors that increase the likelihood of developing melanonychia. While not direct causes, they make the condition more common or more noticeable.
Those at higher risk are:
If melanonychia is not properly addressed, it can sometimes lead to complications such as:
While the majority of the cases are benign, melanonychia can occasionally signal subungual melanoma. This is a rare form of skin cancer that starts in the nail matrix.
Due to its possibilities, it is important to take note of warning signs, which include:
Melanonychia is primarily diagnosed through a detailed clinical assessment and nail examination. The main goal is to determine whether the pigmentation is caused by harmless melanocyte activation or a concerning condition, such as melanoma.
The diagnostic process typically involves:
Medical history
Our dermatologist will begin by asking about your:
Physical and nail examination
Next, your nails are carefully inspected for:
Dermoscopic evaluation
A handheld dermatoscope provides a magnified view of the nail plate and pigment pattern. This helps differentiate benign causes from malignant ones. Generally, the patterns look like:
Additional investigation
If the findings are unclear or suspicious, our dermatologist may order further tests to be done. This may include:
The treatment for melanonychia depends on its underlying cause. While some cases are harmless and only need observation, others may require medical or surgical intervention to rule out or treat serious conditions such as melanoma. Every treatment plan is personalised to ensure both nail health and peace of mind.
But generally, it entails:
Comprehensive assessment
Before treatment begins, our dermatologist will confirm the cause of the pigmentation through detailed examination and, if needed, a biopsy of the nail matrix. Understanding the source of pigmentation helps determine whether the condition is benign or requires further management.
Observation and reassurance
For physiological or medication-related melanonychia, no active treatment may be needed. Instead, our dermatologists may recommend:
Addressing underlying causes
When melanonychia occurs as part of another condition, the focus shifts to managing the primary issue. This includes:
Procedural management
In selected cases, especially when malignancy cannot be ruled out or confirmed, our dermatologists may recommend:
Cosmetic management
For patients bothered by visible streaks but confirmed to have benign melanonychia, camouflage options or, in some cases, laser therapy may be discussed. While cosmetic improvement is possible, the results vary and recurrence may occur.
Aftercare and follow-up
Following treatment, you may be advised to:
If you notice a new dark line, streak or colour change in your nails, especially one that looks irregular or continues to spread, it is always better to get it checked.
Our dermatologists at Livingstone Dermatology are experienced in diagnosing and treating all forms of nail pigmentation. With a thorough assessment, clear explanation and expert care, we will help you find peace of mind and the best way forward.
Book an appointment today to discover how we can aid in your journey to stronger and healthier nails.
Is melanonychia dangerous?
Not always. Many cases of melanonychia are benign and caused by factors such as genetics, medication use or nail trauma. However, since melanonychia can sometimes signal a serious condition like melanoma, it is important to have any new or changing pigmentation examined by a dermatologist.
Can melanonychia go away on its own?
It depends on the cause. Pigmentation linked to medications or injury may fade gradually once the trigger is removed, while genetic or chronic conditions tend to persist. Our dermatologist can monitor the colour changes over time and advise whether treatment is needed or simple observation is enough.
How do I know if my melanonychia is cancerous?
You cannot tell for sure just by looking. But the warning signs include:
If any of these features appear, consult a dermatologist promptly for evaluation and, if necessary, a biopsy to confirm the diagnosis.
Can nail polish or trauma cause melanonychia?
Yes. Frequent use of dark nail polish or artificial nails may stain the nail plate, creating the appearance of pigmentation. Repeated trauma, such as from tight shoes, running or musical instruments, can also stimulate melanocytes, leading to darker streaks. A dermatologist can differentiate between staining, bruising and true melanonychia.
Does melanonychia affect toenails or fingernails more?
It can affect both, though fingernails are more commonly involved. Toenail melanonychia often arises from repeated pressure or friction, especially in athletes or those wearing tight footwear. In contrast, fingernail melanonychia may be linked to a hormonal or drug-related cause.
Is melanonychia contagious?
No, melanonychia is not an infection and cannot spread from person to person. The pigment comes from increased melanin within the nail, not from bacteria or fungi.
How long does it take for treatment results to show?
If the pigmentation is linked to a reversible cause such as trauma or medication, improvement may be seen within a few nail growth cycles, which is usually a few months. However, for chronic or physiological causes, the colour may remain stable. Our dermatologist will advise how often to monitor it.
Can I still paint my nails if I have melanonychia?
In most cases, yes, but moderation is key. Avoid prolonged use of dark polish or harsh removers that can obscure changes or irritate the nail. It is best to let our dermatologist examine your nails regularly if you choose to keep them covered.
Is a biopsy painful?
A nail matrix biopsy is done under local anaesthetic, so discomfort is minimal. Mild tenderness or sensitivity may occur afterwards, but typically settles within a few days. Our dermatologist will ensure you are comfortable throughout the procedure.
How can I keep my nails healthy and reduce the risk of melanonychia?
Simple habits can help protect your nails and maintain their natural appearance:
If you notice any new pigmentation, early assessment allows prompt reassurance and treatment if needed.
