Board-Certified Dermatologist | 34+ Years Experience
Nail changes are common and can occur for many different reasons. Changes in nail color, thickness, texture, shape, or growth may be related to infection, inflammation, trauma, medications, underlying skin conditions, or other medical concerns.
At Yolanda C. Holmes, M.D., P.C., Dr. Holmes provides personalized evaluation and treatment for nail disorders in Washington, DC. As a board-certified dermatologist with more than 34 years of experience and a focus on skin of color, Dr. Holmes considers the appearance of the nails, symptoms, affected fingers or toes, duration of the changes, and individual health and lifestyle factors when determining the appropriate diagnosis and treatment approach.
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Nail disorders are conditions that affect the fingernails, toenails, or the skin surrounding the nails.
Healthy nails are generally smooth and evenly colored, although normal nail appearance can vary between individuals. Changes that are persistent, unusual, or progressive may indicate an underlying condition that should be evaluated.
Nail problems may affect:
Some nail changes are harmless, while others may require medical treatment.
Many different conditions can affect the nails.
A fungal nail infection, also called onychomycosis, can cause nails to become thickened, discolored, brittle, or crumbly. The nail may become yellow, white, or brown and may gradually change in shape.
Nail fungus is more common in toenails but can also affect fingernails.
Nails may become fragile, split, peel, or break for a variety of reasons. Frequent exposure to water, chemicals, trauma, certain nail treatments, and some medical conditions may contribute to nail fragility.
Nails can develop white, yellow, brown, green, or darker areas for different reasons.
Discoloration may be related to infection, trauma, medications, underlying skin conditions, or other causes. A dermatologist can evaluate persistent or unexplained changes.
Nails can become thicker with age, repeated trauma, fungal infection, psoriasis, or other conditions.
Thickened toenails may also become difficult to trim or uncomfortable inside shoes.
An ingrown nail occurs when the edge of a nail grows into the surrounding skin. This can cause pain, swelling, redness, and sometimes infection.
Psoriasis can affect the nails and may cause pitting, ridges, discoloration, thickening, separation of the nail from the nail bed, or other changes.
Nail psoriasis can sometimes occur even when there are few or no obvious psoriasis plaques elsewhere on the skin.
Conditions such as eczema, psoriasis, lichen planus, and other inflammatory skin disorders can affect nail growth and appearance.
Injuries to the nail or repeated pressure can cause discoloration, ridges, splitting, or temporary changes in nail growth.
There is no single cause of nail changes.
Possible causes include:
Because several conditions can produce similar nail changes, it is important not to assume that every thickened or discolored nail is caused by fungus.
Nail disorders can cause a wide range of changes.
You may notice:
Some nail changes may be subtle at first.
Consider scheduling a dermatology evaluation if you notice:
Professional evaluation is especially important when a nail change is new, persistent, or affecting only one nail.
Nail disorders can affect people of every skin tone.
Nail color and pigmentation can naturally vary, and some pigmentary changes around or underneath the nail may be more noticeable depending on a person's natural skin tone.
Dr. Holmes considers the patient's natural pigmentation, nail appearance, surrounding skin, and individual characteristics when evaluating nail changes.
With experience caring for patients with skin of color, Dr. Holmes also considers how inflammatory or pigmentary conditions may present differently across different skin tones.
Learn more about Dermatology for Skin of Color in Washington, DC →
Nail disorders are generally diagnosed through examination of the nails and surrounding skin.
Dr. Holmes may consider:
When a fungal infection is suspected, additional testing may be recommended before treatment.
Depending on the situation, testing may include a nail clipping, scraping, or other laboratory examination to determine whether fungus is actually present.
This distinction is important because not every thickened or discolored nail is caused by fungus, and antifungal treatment will not improve a nail disorder caused by another condition.
Treatment for nail fungus depends on the extent of the infection, the nails involved, and other individual factors.
Depending on the diagnosis, treatment may include:
Nails grow slowly, particularly toenails, so improvement may take time even after the infection has been successfully treated.
Because several nail conditions can look similar to fungal infections, laboratory confirmation may sometimes be recommended before starting oral antifungal medication.
Learn more about Fungal Skin Infection Treatment in Washington, DC →
Nail fungus generally does not resolve quickly without treatment.
Because nails grow slowly, fungal infections can persist for a long time and may gradually become more extensive.
If you suspect a fungal nail infection, professional evaluation can help determine whether fungus is actually responsible and whether treatment is appropriate.
Yes.
Some nail conditions are primarily cosmetic, while others can cause significant discomfort.
Pain may occur with:
Painful or worsening nail changes should be evaluated rather than ignored.
Dark lines or areas of pigmentation under a nail can have several causes.
They may result from:
In some cases, however, a new or changing dark streak under a nail can be a sign of melanoma of the nail unit.
A new, changing, widening, or irregular dark streak should therefore be evaluated by a dermatologist rather than assumed to be harmless.
Yes.
The nails can sometimes provide clues about conditions affecting the skin or other parts of the body.
Nail changes may occur with conditions such as:
A dermatologist can determine whether the nail changes appear consistent with an isolated nail disorder or whether additional evaluation may be appropriate.
Certain nail-care practices may contribute to irritation or nail damage.
Helpful habits may include:
If you regularly use artificial nails, gel manicures, acrylics, or other nail products and develop persistent nail changes, discuss the products and application practices with your dermatologist.
Some nail disorders can recur.
For example, fungal nail infections may return after treatment, particularly when contributing factors remain.
Inflammatory nail conditions such as psoriasis may also require ongoing management.
Following the recommended treatment plan and addressing factors that contribute to the condition may help reduce recurrence.
Nails grow slowly, so nail treatment often requires patience.
Even when the underlying condition has been successfully treated, a damaged nail may continue to look abnormal until healthy nail grows out.
Fingernails generally grow faster than toenails, so toenail changes may take considerably longer to become fully replaced by healthy nail.
The expected treatment timeline depends on the specific diagnosis and the extent of nail involvement.
Not every nail irregularity indicates disease.
Minor ridges, changes associated with aging, or temporary changes after trauma can sometimes be harmless.
However, persistent, progressive, painful, or unexplained changes should be evaluated by a dermatologist, particularly when only one nail is affected or when pigmentation changes are present.
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Board-Certified Dermatologist
with 34+ years of experience
Comprehensive Nail Evaluation
for infections, inflammatory conditions, growth abnormalities, and unexplained nail changes
Accurate Diagnosis
with additional testing when appropriate
Individualized Treatment Plans
based on the underlying condition and extent of nail involvement
Experience with All Skin Types
including patients with skin of color
Recognized
2025 Best Dermatologist in Dupont Circle
Dr. Yolanda C. Holmes is a board-certified dermatologist with more than 34 years of experience serving patients in Washington, DC.
She provides individualized evaluation and treatment for nail disorders, fungal infections, inflammatory skin conditions, and other dermatologic concerns. Dr. Holmes considers the appearance and pattern of nail changes, symptoms, medical history, and individual factors when determining whether treatment or additional evaluation may be appropriate.
With a focus on skin of color, Dr. Holmes considers each patient's natural pigmentation and individual skin characteristics when evaluating nail and skin conditions.
Learn more about Dr. Holmes →
If you have a persistent, painful, discolored, thickened, or otherwise unusual nail change, a dermatology evaluation can help determine the underlying cause. Not every nail problem is nail fungus, and getting the correct diagnosis is an important first step toward appropriate treatment.
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