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Can Fingernail Changes Be a Symptom of MS?

Posted on April 12, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Sarah Winfrey

Can MS Cause Fingernail Changes? | Other Potential Causes | Support

Many MyMSTeam members have wondered about changes to their fingernails that occurred after their multiple sclerosis (MS) diagnosis. Some wonder whether a systemic disease such as MS can cause fingernail problems or whether they need to look elsewhere to figure out why their fingernails have changed.

In this article, we will consider member anecdotes and research on how multiple sclerosis may affect the nails. If you think you may be experiencing nail changes as a symptom of MS, talk to a health care professional. They can help determine the cause and work with you to find the best way to manage it.

Can MS Cause Changes to the Fingernails?

Many MyMSTeam members have experienced nail changes after their MS diagnoses. As one wrote, “I have grooves in my finger and toenails.” Another described their fingernails as “dry and brittle,” while a third asked, “Anyone else get flat spots on their fingernails? I have not always had them and only noticed after I was diagnosed.”

One member said their health care provider regularly checks their nails for changes: “The doctor always looks at my fingernails. I brought the ridges up, and he said that a lot of people with autoimmune diseases seem to have them.”

There doesn’t seem to be a direct connection between multiple sclerosis and most of the nail abnormalities that people experience. However, some research has suggested that people with MS may experience certain nail changes.

Fungal Infections

Onychomycosis is a fungal infection of the fingernails (and toenails). It can affect any area of the nail and cause pain, discomfort, discoloration, thickening, and crumbling at the nail edges. (DermNetNZ.org)

Onychomycosis is a fungal infection and a nail disorder that can affect the fingernails. This fungal infection may cause the nails to become thick, separate from the nail bed, and appear discolored. According to one study, onychomycosis is slightly more common in people diagnosed with MS than it is in the general population.

Because the study sample was relatively small and the increase in fungal nail infections was minimal (32 percent vs. 26 percent), researchers recognize that more work needs to be done to confirm this connection. However, this finding does mean that people with MS should ask their doctor about a fungal infection if they notice changes to their nails such as thickening, discoloring, and separation.

Drug Interactions

The MS drug teriflunomide can case psoriasiform changes, which are changes that resemble the skin condition psoriasis. Symptoms include nails appearing thicker, as well as discoloration, scales, and inflammation. (DermNetNZ.org)

One medication often prescribed to treat multiple sclerosis, teriflunomide (Aubagio), can cause significant changes to the fingernails. Specifically, teriflunomide can cause fingernails to develop psoriasiform changes — that is, changes that resemble symptoms of the inflammatory skin condition psoriasis.

People with these changes may develop fingernails that appear thicker than usual, red and scaly, and inflamed. A person who experiences these nail changes may need to be evaluated for psoriasis to make sure that they are getting the proper treatment.

In addition, teriflunomide may actually cause psoriasis in some people. Thus, a dermatologist may be needed to differentiate between a person with MS whose hands appear psoriatic and someone who has actually developed psoriasis.

Some people who take teriflunomide may experience total fingernail loss, though this side effect is rare and usually reversible. The nail should grow back after the person discontinues the medication.

If a person with MS experiences these types of side effects, they may need to decide whether taking this particular medication is the best option for them. People with MS should consult with a health care provider to get medical advice before making any changes to their medication.

Learn more about switching MS treatments.

What Else Could Cause Fingernail Changes in People With Multiple Sclerosis?

Nail changes can indicate several different conditions or problems going on in the body. People diagnosed with multiple sclerosis should talk to their primary care doctors, dermatologists, or neurologists if they are experiencing changes to their fingernails. Some changes may indicate a comorbidity — a second, separate medical condition — that they should get treated for as soon as possible.

Beau’s Lines

MS flare-ups can sometimes cause Beau’s lines, characterized by deep horizontal indentations across the nail. (DermNetNZ.org)

Beau’s lines are horizontal indentations that go all or most of the way across a fingernail. These lines most commonly occur when nail growth at the cuticle occurs at the same time the finger is injured or during a severe illness.

However, these lines can also indicate:

  • Diabetes that is not under control
  • A recent high fever from an illness such as pneumonia
  • Vascular problems in the finger and the nail
  • A thyroid issue or thyroid disease

People with MS may occasionally experience Beau’s lines after a flare-up, though they should get checked for these other conditions, as well.

Nail Pitting

Nail pitting is another potential side effect of the MS drug teriflunomide. The pitting may resemble dents or small holes in your nails. (DermNetNZ.org)

People who experience nail pitting say that it looks like someone chipped away at their nails with a tiny ice pick. This nail symptom is most common in people diagnosed with psoriasis or as a side effect of teriflunomide. However, nail pitting can also indicate autoimmune disorders, such as alopecia areata and Reiter’s syndrome.

While there is no literature connecting multiple sclerosis to either of these immune system disorders (beyond a single case of alopecia areata), it’s best to get evaluated for them if your nails have pits. MS can be complicated by other autoimmune conditions, and it’s best to figure out what is going on right away.

Nail Ridges

Nail ridges resemble Beau’s lines, except the lines run vertically instead of horizontally. (DermNetNZ.org)

Nail ridges are similar to Beau’s lines but instead run up and down the length of the nail rather than across it. These ridges may indicate:

  • Rheumatoid arthritis
  • An injury to the nail
  • A nutritional deficiency of folic acid, protein, or iron

People with MS may be at a higher risk of developing rheumatoid arthritis, so they should consult a doctor to rule this condition out first. After that, a registered dietician may be needed to evaluate their diet and make sure they are getting enough folic acid, protein, and iron.

Yellow Nails

Sometimes, fingernails appear to turn yellow. This discoloration usually happens when the nails grow more slowly than normal and grow thicker rather than longer. Yellowed nails can be a side effect of swollen hands or indicate a respiratory disease.

Yellow nails may also indicate a fungal infection, like onychomycosis. In extreme cases, yellow nails can indicate liver disease, but it’s unlikely that a person would not already know they had liver disease before their nails turned yellow.

Yellow nails may result from a fungal infection or, in extreme cases, from liver disease. (DermNetNZ.org)

Separated Nails

With onycholysis, a person’s nails separate or detach from their nail beds. It can result from a fungal infection or from one of several other conditions, including lung disease or a vitamin C deficiency. (DermNetNZ.org)

The separation or detachment of nails from the nailbed is referred to as onycholysis. Onycholysis can be a symptom of a fungal infection, but it can also stem from other causes. Nail separation can be associated with conditions including:

  • Lung disease
  • Leukemia
  • A vitamin C deficiency
  • Lupus
  • Lung cancer

However, nail separation most often does not indicate a systemic problem. People with MS who experience this symptom should have it evaluated by a professional, just to be sure.

Find Your MS Team Today

On MyMSTeam, the social network for people diagnosed with MS and those who love and care for them, more than 183,000 members come together to ask questions, give advice, and share their experiences with others who understand.

Have you experienced fingernail changes with MS? Share your thoughts in the comments below or by posting on MyMSTeam.

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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