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Last updated: September 25, 2025View editorial policy

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Differential Diagnosis for Toenail Discoloration

Single Most Likely Diagnosis

  • Fungal infection (onychomycosis): This is the most common cause of toenail discoloration, often resulting in a yellow, brown, or black appearance due to the fungal invasion of the nail.

Other Likely Diagnoses

  • Trauma: Injury to the nail can cause discoloration, typically presenting as a black or purple color under the nail due to blood accumulation.
  • Nail psoriasis: This condition can lead to nail discoloration, pitting, and thickening, often with a yellowish or brownish tint.
  • Aging: As people age, their toenails may become thicker and more prone to discoloration, often taking on a yellowish hue.
  • Staining from substances: Exposure to certain chemicals or substances (like nail polish) can stain the nails, leading to discoloration.

Do Not Miss Diagnoses

  • Melanoma: Although rare, subungual melanoma can present as a dark streak under the nail and is potentially life-threatening if not diagnosed early.
  • Squamous cell carcinoma: This type of skin cancer can also affect the nail bed, leading to discoloration and other nail changes.
  • Systemic diseases (e.g., diabetes, liver or kidney disease): Certain systemic conditions can cause nail changes, including discoloration, and it's crucial to identify these underlying diseases.

Rare Diagnoses

  • Yellow nail syndrome: A rare condition characterized by thickened, yellowish nails that are often associated with lymphedema and respiratory diseases.
  • Argria (silver poisoning): Exposure to silver can cause a bluish-gray discoloration of the nails.
  • Minocycline-induced nail discoloration: Long-term use of minocycline, an antibiotic, can lead to a blue-gray discoloration of the nails.
  • Other rare genetic or systemic conditions that may affect nail pigmentation.

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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