Table of ContentsView AllTable of ContentsClubbingMelanonychiaOnychomycosisAnolunulaTerry’s Nails
Table of ContentsView All
View All
Table of Contents
Clubbing
Melanonychia
Onychomycosis
Anolunula
Terry’s Nails
This article describes five nail conditions that commonly affect people with HIV, including their symptoms and treatments.
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Digital clubbing—also known ashypertrophic osteoarthropathy—is the curving of nails around a person’s fingertips or toes. This can make nails look like upside-down spoons.
Symptoms of digital clubbing include:
In people with HIV, clubbing most often occurs in children with HIV, although it can also affect adults withadvanced untreated HIV.
Clubbing occurs with many medical conditions but is generally the result of chronic low levels of oxygen in your blood, known ashypoxemia.
Hypoxemia is common in babies who have been infected with HIV while in the womb or passing through the birth canal.It is also common withHIV-associated lung disease in adults, where clubbing is a characteristic symptom.
Currently, there is no treatment for clubbing. With that said, treating the underlying condition can often reverse the symptoms and make the nails look normal again.
Melanonychiais a type of nail discoloration that causesblack or brown lineson fingernails or toenails. Though melanonychia can occur with many conditions—including pregnancy,melanoma, andAddison’s disease—both HIV and certainHIV drugsare known to trigger this otherwise uncommon symptom.
Symptoms of melanonychia include:
Melanonychia is most closely associated with the HIV drugzidovudinefound in combination medications like Combivir (lamivudine/zidovudine) and Trizivir (abacavir/lamivudine/zidovudine).
There have also several cases where people with HIV developed melanonychia in the absence of HIV therapy. The cause is unclear but appears to mainly affect Black people and those with darker skin tones.
Melanonychia is not dangerous or painful, but some people find it unsightly. Changing from zidovudine to some other drug might help. You can also conceal the discoloration with nail polish.
Onychomycosis—also known astinea unguium—is the medical term for afungal nail infection.
Anyone can get onychomycosis, but people with HIV are disproportionately affected because the infections tend to beopportunistic(meaning they occur when the immune system is down). The infections also tend to be more severe and harder to treat in people with HIV.
Symptoms of onychomycosis include:
Onychomycosis can affect fingernails but is more common in toenails due to the high moisture in feet that promotes fungal growth.
Over-the-counterantifungal creamslike Lamisil (terbinafine) are not very useful in getting rid of the fungus. Oral prescription antifungals like terbinafine, itraconazole, and ketoconazole are far more effective, but they can two to three months to work and cause significant side effects, including liver injury.
In severe cases, the entire nail might have to be removed to better deal with the fungal infection.
The half-moon-shaped, white area near the base of a nail is called thelunula. The absence of the lunula is calledanolunula. The condition is typically painless and causes no other symptoms.
Anolunula disproportionately affects people with HIV, gradually getting worse as the immune system andCD4 count(a measure of immune function) decline. The progressive “shrinking” of the lunula can lead to total anolunula in which no whiteness is seen, typically when theimmune system is fully compromised.
The absence of the lunula is often an indication of an underlying health problem like malnutrition, anemia, kidney failure, or heart disease. With HIV, the long-term inflammation associated with the infection is thought to damage tiny blood vessels in the nail bed, causing this uncommon nail symptom.
There is no known treatment for anolunula.
Terry’s nails, also known asapparent leukonychia, cause tissues underneath the nail to become abnormally white and washed out.
Symptoms of Terry’s nails include:
Terry’s nails occur with many long-term, systemic (whole-body) diseases, including HIV and diabetes. It may also be asign of aging.
Summary
Though none of the conditions are dangerous, they may be a sign of disease progression in people with HIV.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Medline Plus.Clubbed fingers.Attia EF, Weiss NS, Maleche-Obimbo E, et al.Risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi.Pediatr Infect Dis J. 2017 Apr;36(4):e93–e97. doi:10.1097/INF.0000000000001453Flores-Bozo LR, Mendez-Flores S, Olvera-Rodriguez V, et al.Nail changes in people living with human immunodeficiency virus: observational and cross-sectional study in a third-level hospital.Skin Appendage Disord.2022 Sep;8(5):368–375. doi:10.1159/000524257Singal A, Arora R.Nail as a window of systemic diseases.Indian Dermatol Online J. 2015;6(2):67-74. doi:10.4103/2229-5178.153002Visuvanathan V, Koh K.Dark fingernails.Malays Fam Physician. 2015;10(3):40-42.American Association of Dermatology Association.Nail fungus: diagnosis and treatment.Gahalaut P, Mishra N, Chauhan S, Ali MM, Rastogi MK, Thakur R.Anolunula in fingernails among patients infected with HIV.ISRN Dermatol. 2014;2014. doi:10.1155/2014/271230Witkowska AB, Jasterzbski TJ, Schwartz RA.Terry’s nails: a sign of systemic disease.Indian J Dermatol. 2017;62(3):309-311. doi:10.4103/ijd.IJD_98_17
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Medline Plus.Clubbed fingers.Attia EF, Weiss NS, Maleche-Obimbo E, et al.Risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi.Pediatr Infect Dis J. 2017 Apr;36(4):e93–e97. doi:10.1097/INF.0000000000001453Flores-Bozo LR, Mendez-Flores S, Olvera-Rodriguez V, et al.Nail changes in people living with human immunodeficiency virus: observational and cross-sectional study in a third-level hospital.Skin Appendage Disord.2022 Sep;8(5):368–375. doi:10.1159/000524257Singal A, Arora R.Nail as a window of systemic diseases.Indian Dermatol Online J. 2015;6(2):67-74. doi:10.4103/2229-5178.153002Visuvanathan V, Koh K.Dark fingernails.Malays Fam Physician. 2015;10(3):40-42.American Association of Dermatology Association.Nail fungus: diagnosis and treatment.Gahalaut P, Mishra N, Chauhan S, Ali MM, Rastogi MK, Thakur R.Anolunula in fingernails among patients infected with HIV.ISRN Dermatol. 2014;2014. doi:10.1155/2014/271230Witkowska AB, Jasterzbski TJ, Schwartz RA.Terry’s nails: a sign of systemic disease.Indian J Dermatol. 2017;62(3):309-311. doi:10.4103/ijd.IJD_98_17
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Medline Plus.Clubbed fingers.Attia EF, Weiss NS, Maleche-Obimbo E, et al.Risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi.Pediatr Infect Dis J. 2017 Apr;36(4):e93–e97. doi:10.1097/INF.0000000000001453Flores-Bozo LR, Mendez-Flores S, Olvera-Rodriguez V, et al.Nail changes in people living with human immunodeficiency virus: observational and cross-sectional study in a third-level hospital.Skin Appendage Disord.2022 Sep;8(5):368–375. doi:10.1159/000524257Singal A, Arora R.Nail as a window of systemic diseases.Indian Dermatol Online J. 2015;6(2):67-74. doi:10.4103/2229-5178.153002Visuvanathan V, Koh K.Dark fingernails.Malays Fam Physician. 2015;10(3):40-42.American Association of Dermatology Association.Nail fungus: diagnosis and treatment.Gahalaut P, Mishra N, Chauhan S, Ali MM, Rastogi MK, Thakur R.Anolunula in fingernails among patients infected with HIV.ISRN Dermatol. 2014;2014. doi:10.1155/2014/271230Witkowska AB, Jasterzbski TJ, Schwartz RA.Terry’s nails: a sign of systemic disease.Indian J Dermatol. 2017;62(3):309-311. doi:10.4103/ijd.IJD_98_17
Medline Plus.Clubbed fingers.
Attia EF, Weiss NS, Maleche-Obimbo E, et al.Risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi.Pediatr Infect Dis J. 2017 Apr;36(4):e93–e97. doi:10.1097/INF.0000000000001453
Flores-Bozo LR, Mendez-Flores S, Olvera-Rodriguez V, et al.Nail changes in people living with human immunodeficiency virus: observational and cross-sectional study in a third-level hospital.Skin Appendage Disord.2022 Sep;8(5):368–375. doi:10.1159/000524257
Singal A, Arora R.Nail as a window of systemic diseases.Indian Dermatol Online J. 2015;6(2):67-74. doi:10.4103/2229-5178.153002
Visuvanathan V, Koh K.Dark fingernails.Malays Fam Physician. 2015;10(3):40-42.
American Association of Dermatology Association.Nail fungus: diagnosis and treatment.
Gahalaut P, Mishra N, Chauhan S, Ali MM, Rastogi MK, Thakur R.Anolunula in fingernails among patients infected with HIV.ISRN Dermatol. 2014;2014. doi:10.1155/2014/271230
Witkowska AB, Jasterzbski TJ, Schwartz RA.Terry’s nails: a sign of systemic disease.Indian J Dermatol. 2017;62(3):309-311. doi:10.4103/ijd.IJD_98_17
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