Ask the Pharmacist

Q) My nails have turned yellow. Why would this be and what can I do about it?

A) There is a lot your nails can tell you about your overall health so it can be of great benefit to pay some attention to them every once in a while. In the case of yellowing of the nail bed, there are a variety of reasons why this can occur that can be separated into two broad categories.

The first is as that it is a result of an underlying medical condition. The other is that the yellowing is a by-product of using cosmetic products on your nails. It is usually pretty easy to distinguish between these two possible answers. If the staining is the result of the use of nail polish then the nail will be healthy looking and intact but have a yellow hue throughout. The nail surface will be smooth and of normal thickness. When the nail discolouration is caused by a medical disorder, the nail is usually thick and frequently crumbly and looks unhealthy overall regardless of its colour.

The other way to distinguish between the two is, of course, to look at a person’s history. If the individual does not use nail cosmetics, than the answer is rather self evident. One of the most common causes of yellow staining is from nail lacquer. Our nails are not the hard impenetrable shields many of us consider them to be but are instead quite porous allowing chemicals to pass in to them. The extent to which this occurs depends on many factors, not the least of which is your genetics.

This means that some individuals are going to be more susceptible to staining than others despite using the same products and techniques when it comes to nail care. The physiological explanation behind this phenomenon is rather complicated but in a nutshell what occurs is that some of the pigments from the lacquer “migrate” into our nail bed and take up permanent residence resulting in a yellowing of the nail.

Beyond the lacquer, the use of nail polish remover is another common culprit when it comes to discolouration as well. The last factor related to cosmetic induced yellowing is related to the dye content of the polish itself. Not all polishes are the same. In general, the darker the colour, the more likely it is that the pigment will leach in to the nail bed long term.

That being said any colour of polish can cause this effect and there is no brand of nail polish that I am aware of that is free from the possibility of inducing this colour change. When it comes to treating this, there are a number of options (tea tree oil, oil of oregano, baking soda…) but the two with the most evidence are as follows:

  • The first solution is not to treat at all but to camouflage it with additional polish. This may seem ridiculous but we are not talking about ignoring a serious medical disorder here. It is strictly an aesthetic issue.
  • The second solution is to take a holiday from using polish and try soaking your nails for 2 minutes in a hydrogen peroxide solution. The recipe for this is to add 3 to 4 tablespoonfuls of hydrogen peroxide (available for very little money at virtually every pharmacy) to a half cup of water. After soaking, take a toothbrush and gently scrub the nails before rinsing them off with water. Repeat this two to three times a week as needed.  For those with a little less energy, a whitening toothpaste which uses hydrogen peroxide can be used in place of the homemade remedy.

To prevent this from happening in the first place or from re-occurring, a number of steps can be undertaken. The first is to keep the nail healthy by moisturizing it on occasion and not overfilling them. As well, using a good quality base coat will create a protective layer for the nail. Lastly, do not use nail polish remover more than once a week and use a less harsh product that does not contain acetone. As well, try to remove the polish quickly. If you need to rub for more than 10 minutes, than the pigments will have a better opportunity to imbed themselves within the nail.

There are other non-medical causes of nail yellowing beyond cosmetics. These include staining from exposure to ingredients such as tobacco, tanning products or Henna.

As far as possible underlying medical conditions that might lead to this, the most common by far are fungal infections of the nail. This is known medically as onychomycosis and this leads to nails (usually toe rather than finger ones) that are thickened, crumbly &, in keeping with our theme, yellow. There are a number of treatments for this which we have covered in past discussions so I won’t go into details here.

Onycholysis (separation of the nail plate from its underlying bed) is another potential source of nail yellowing. This is commonly observed on the fingernails and involves the nail lifting off of the bed (usually due to overly aggressive cleaning under the nail) which then allows moisture to settle there. This provides an ideal breeding ground for yeast that subsequently produces the yellow appearance.

There are, unfortunately, more serious medical conditions that can also lead to yellowing of the nails. These include rheumatoid arthritis, chronic lung conditions, psoriasis, thyroid conditions, diabetes, sinusitis, jaundice (a sign of a liver disorder), cancer (most commonly skin cancer but other types as well), a lymphatic obstruction or a possible vitamin or mineral deficiency.

Given the serious nature of most of these disorders, it would be prudent to let a doctor take a look at your yellowed nails unless you are sure it is a polish induced problem. This is particularly true if the nails are painful, there is bleeding from the skin underneath, swelling of the underlying tissues or if there have been changes to the shape or thickness of the nail plate. It is more likely than not that it’s all just an aesthetic issue, but as they say, it’s better to be safe than sorry.