What is the cause of a black line on the fingernail, also known as melanonychia (melanonychia)?

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Last updated: May 14, 2025 • View editorial policy

Differential Diagnosis for Black Line on Fingernail

  • Single Most Likely Diagnosis + Melanonychia: This condition is characterized by a black or brown streak on the nail plate, often caused by activation or proliferation of melanocytes in the nail matrix. It's a common and usually benign condition.
  • Other Likely Diagnoses + Nail trauma: A black line on the fingernail can result from trauma to the nail, such as a bruise or hematoma under the nail plate. + Nail fungus (onychomycosis): Fungal infections can cause discoloration, including black lines, on the nail. + Nail staining: Exposure to certain chemicals or substances can stain the nail, resulting in a black line.
  • Do Not Miss Diagnoses + Subungual melanoma: Although rare, a black line on the fingernail can be a sign of subungual melanoma, a type of skin cancer that occurs under the nail. Early detection is crucial for treatment. + Endocarditis: In rare cases, a black line on the fingernail can be associated with endocarditis, an infection of the heart valves.
  • Rare Diagnoses + Addison's disease: This rare endocrine disorder can cause hyperpigmentation, including dark lines on the nails. + Peutz-Jeghers syndrome: A rare genetic disorder characterized by intestinal polyps and mucocutaneous melanin deposits, which can cause dark lines on the nails. + Laugier-Hunziker syndrome: A rare condition characterized by hyperpigmentation of the nails, oral mucosa, and skin.

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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.