What are the causes of linear dark nail discoloration (melanonychia)?

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Differential Diagnosis for Nail Linear Dark

  • Single most likely diagnosis
    • Melanonychia: This condition is characterized by a linear dark streak in the nail, often caused by an increase in melanin production. It can be benign or associated with melanoma.
  • Other Likely diagnoses
    • Nail trauma: Trauma to the nail can cause linear dark streaks due to bleeding or inflammation under the nail plate.
    • Nail fungus (onychomycosis): Certain types of fungal infections can cause dark discoloration of the nail, including linear streaks.
    • Vitamin deficiencies: Deficiencies in vitamins like B12 or vitamin C can cause changes in nail color, including linear dark streaks.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Subungual melanoma: A type of skin cancer that can present as a linear dark streak under the nail. Early detection is crucial for treatment and survival.
    • HIV-associated nail changes: Certain nail changes, including linear dark streaks, can be associated with HIV infection.
  • Rare diagnoses
    • Addison's disease: A rare endocrine disorder that can cause hyperpigmentation, including linear dark streaks in the nails.
    • Peutz-Jeghers syndrome: A rare genetic disorder characterized by intestinal polyps and mucocutaneous melanin deposits, which can cause linear dark streaks in the nails.
    • Laugier-Hunziker syndrome: A rare condition characterized by hyperpigmentation of the nails, lips, and oral mucosa, which can cause linear dark streaks in the nails.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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