Green nail syndrome, also known as chloronychia, is a condition that causes the nail beds to take on a greenish tint. It is typically harmless but can sometimes indicate an underlying health issue. Here is an in-depth look at what causes green nail syndrome, how it is diagnosed, treatment options, and whether it eventually goes away on its own.
What Causes Green Nail Syndrome?
There are a few potential causes of green nail syndrome:
- Pseudomonas bacteria – The most common cause is a bacterial infection of the nail beds, typically with Pseudomonas bacteria. This bacteria naturally occurs on the skin and thrives in warm, moist environments like pools and hot tubs.
- Fungal infection – In some cases, a fungal nail infection can also cause green discoloration of the nails.
- Chemical exposure – Exposure to certain chemicals like detergents, nail polish, artificial nails, and even hair dyes can stain the nails green.
- Trauma – Injury to the nail beds, such as repeatedly hitting the nails or dropping something on them, can cause green discoloration.
- Underlying illness – More rarely, green nails may result from an underlying health condition like diabetes, liver disease, or iron deficiency anemia.
Who is at Risk for Green Nail Syndrome?
Certain individuals have a higher risk of developing green nail syndrome:
- Swimmers or frequent hot tub users – The warm, humid environment promotes Pseudomonas bacterial growth.
- People with compromised immune systems – Those with weakened immune systems are more prone to nail infections.
- Diabetics – Have a higher risk of nail fungal infections.
- Older adults – More likely to have low circulation or nail trauma.
- Healthcare workers – Frequent handwashing and glove use can damage nail beds.
- Nail biters – Damaging the nails increases infection risk.
- Individuals exposed to irritating chemicals – Hair stylists, housekeepers, etc.
Symptoms of Green Nail Syndrome
In addition to green colored nails, other symptoms of green nail syndrome can include:
- Thickened or brittle nails
- Crumbling or distorted nail shape
- Debris accumulating under nails
- White/yellow streaks or spots on nails
- Pain or tenderness of the nail
- Swollen, red or inflamed skin around nail
- Strong foul odor from nails
- Nail loosening or detachment from nail bed
When to See a Doctor
In most cases, green nail syndrome does not require medical treatment. However, it’s a good idea to see your doctor if you notice any of the following:
- The discoloration spreads to affect multiple nails.
- You have additional symptoms like pain, swelling, foul odor, or nail detachment.
- You have a compromised immune system or diabetes.
- The nails become very thick, brittle or crumbly.
- Discoloration persists for more than a few months.
- You have no known history of chemical exposure or nail trauma.
Getting a proper diagnosis from your doctor can determine if an underlying medical condition is contributing to the green nails. It also allows them to provide proper treatment if a fungal or bacterial infection is present.
Diagnosing Green Nail Syndrome
To diagnose the cause of green nail syndrome, a doctor will typically:
- Ask questions about symptoms and medical history.
- Examine the nails and surrounding skin.
- Take nail clippings for laboratory testing.
- Order blood tests to check for diabetes, anemia or other illnesses.
- Possibly order a biopsy to examine nail cells.
- Culture the nails to test for bacterial or fungal infection.
Once the underlying cause is identified, appropriate treatment can begin.
Treatment for Green Nail Syndrome
Treatment depends on the cause of the discolored nails:
- Bacterial infection – Antibiotic creams, oral antibiotics, medicated nail polishes.
- Fungal infection – Antifungal pills or creams, removal of infected nails.
- Chemical exposure – Stop use of irritating products, apply moisturizers.
- Trauma – Protect nails from further injury to allow new growth.
- Underlying illness – Treat the primary disease such as diabetes or iron deficiency.
In mild cases with no clear underlying cause, over-the-counter antifungal creams containing clotrimazole or antiseptic solutions like Betadine can help clear discoloration. Improving nail hygiene and moisture is also important.
Home Care for Green Nails
In addition to medical treatment, the following home care tips can help improve green nail syndrome:
- Trim nails straight across to avoid ingrown edges.
- Wear gloves during housework and gardening.
- Thoroughly dry hands and feet after washing.
- Avoid damaging manicures or artificial nails.
- Use an antifungal spray on feet after showering.
- Apply an antifungal or antibacterial cream daily.
- Soak nails in a 50/50 vinegar and water solution.
- Routinely disinfect nail tools and files.
What’s the Outlook for Green Nail Syndrome?
With proper treatment, green nail syndrome often resolves within several months as the discoloration grows out with new nail growth. However, it can take up to 18 months for the nails to completely return to a normal color.
If an underlying condition like diabetes is causing the green nails, it may recur unless that illness is properly managed. Fungal nail infections have a tendency to persist and reoccur as well.
In most cases, green nail syndrome does eventually go away on its own. But it is important to see a doctor if:
- The discoloration fails to improve or spreads to more nails.
- Additional symptoms like pain, odor or detachment develop.
- An untreated bacterial or fungal nail infection could worsen.
- You have other medical conditions or are in a high risk group.
While waiting for greenish nails to grow out, using cosmetic nail polishes or false nails can temporarily conceal the discoloration.
When to Seek Emergency Treatment
Seek prompt emergency care if you experience:
- Sudden or severe nail pain
- Bleeding from under or around the nail
- Signs of a nailbed infection like redness, swelling, or pus
- A partially detached nail
- Green or black discoloration of multiple nails within 24 hours
- A compromised immune system and fever or chills
Rapid worsening of symptoms can indicate a serious nail infection requiring antibiotics or surgical drainage. Diabetics with green nails and fever may have a developing foot ulcer or sepsis.
Preventing Green Nail Syndrome
You can reduce the risk of developing green nail syndrome by:
- Practicing good nail hygiene like regularly trimming and cleaning under nails.
- Avoiding damage to nails from trauma or repetitive wetting.
- Wearing shower shoes in public pools, showers, and locker rooms.
- Letting nails dry thoroughly after hand washing or bathing.
- Wearing gloves for wet work or chemical exposure.
- Treating nail fungal infections early.
- Managing underlying medical conditions like diabetes.
With diligent nail care and prompt treatment if signs of infection occur, you can lower your risks of unsightly green nails.
Conclusion
Green nail syndrome is typically harmless but can be bothersome if it persists long term. Discoloration most often results from pseudomonas bacterial or fungal nail infections. Proper diagnosis allows treatment with topical or oral antibiotics, antifungals, or other measures based on the underlying cause. While it may take up to 18 months for green nails to fully grow out, practicing good nail hygiene and seeking treatment can help prevent recurrence and complications like detached or distorted nails. With a diligent approach, green nail syndrome often resolves without serious consequences.
