Nail disorders include changes in the color, thickness, shape, or attachment of the fingernails and toenails. Common causes are fungal infection (onychomycosis), psoriasis, lichen planus, trauma, and reactions to medications. Nail changes are also very common during cancer treatment: taxane chemotherapy, EGFR inhibitors, and other targeted therapies can cause painful inflammation around the nail, lifting, discoloration, and loss. Because the nail grows slowly, changes reflect what was happening months earlier.

What causes nail changes?

Fungus is the most common cause of thick, yellow, crumbly toenails. Pitting and lifting suggest psoriasis; ridging and splitting suggest lichen planus; a dark streak needs evaluation to rule out melanoma. During cancer therapy, paronychia (painful redness around the nail), onycholysis (lifting), and pigment bands are frequent and can affect daily function.

Which nail changes need a dermatologist?

A new dark streak or band in one nail, nails that are painful or draining, nails lifting from the bed, sudden changes across several nails, or nail changes during cancer treatment that make it hard to use your hands or walk.

How are nail disorders treated?

Fungal nails are confirmed by testing and treated with oral or topical antifungals. Psoriasis and lichen planus of the nail respond to injected or topical steroids and to systemic therapy when skin disease is also present. Cancer-therapy nail toxicity is managed with soaks, topical antibiotics and steroids, nail care instruction, and, when needed, minor procedures, all aimed at keeping the patient on treatment.

How Tono treats nail disorders

Tono's board-certified dermatologists see patients with nail changes within days, not months, by video visit in 33 states and in person at Tono clinical centers. Our supportive oncodermatology team manages chemotherapy- and targeted-therapy nail toxicity so patients can continue treatment, and our general dermatologists evaluate and treat fungal, psoriatic, and unexplained nail changes. Your visit ends with a written plan, prescriptions sent to your pharmacy, and follow-up scheduled with the same dermatologist. Most insurance is accepted and no referral is required.

When should I see a dermatologist for nail changes?

See a dermatologist for a single dark nail streak, painful or infected nails, nails lifting or crumbling, or nail changes that began with a new medication or cancer therapy.