Purple or blue nails can be caused by a variety of conditions, ranging from harmless to potentially serious causes. Some common causes include bruising, fungal infections, bacterial infections, lack of oxygen, blood circulation problems, medications, and certain diseases. Determining the underlying cause is important in order to get proper treatment. Mild cases can often be treated at home, while more serious causes may require medical treatment.
What Causes Purple Nails?
Here are some of the most common causes of purple, blue or gray nails:
| Cause | Description |
| Bruising | Injury to the nail or fingertip can cause blood to collect under the nail, appearing as a purple, blue or black discoloration. This is common after jamming or hitting a finger. |
| Fungal infection | A fungal nail infection can cause the nail to thicken and discolor as debris builds up under and around the nail. The nails may turn white, yellow, brown or purple. |
| Bacterial infection | An infection around the nail fold from bacteria like pseudomonas can appear as a blue-green discoloration of the nail. |
| Lack of oxygen | Poor circulation or conditions like pneumonia or heart failure can prevent adequate oxygen from reaching the fingers and toes. This can make the nail beds appear blue or purple. |
| Raynaud’s phenomenon | This condition causes the fingers and toes to become very cold, numb and change color in response to cold temperatures or stress. The skin may turn white, then blue, then red as the blood flow returns. |
| Medications | Certain medications like chemotherapy drugs, antimalarials and antibiotics can cause purple nail discoloration in some people as a side effect. |
| Diseases | Some underlying conditions like diabetes, lupus and thyroid disorders can disrupt nail bed circulation and oxygenation, leading to purple nails. |
As you can see, many different types of problems can lead to purple nail discoloration. Getting the right diagnosis is key to determining the appropriate treatment.
Diagnosing the Cause of Purple Nails
If you notice a new purple, blue or gray discoloration in one or more nails, it’s important to see a doctor for an evaluation. They will ask about your symptoms and perform a physical exam of your affected nails and fingers or toes.
Diagnostic tests that may be used include:
– Fungal culture – Clippings are taken to check for a fungal nail infection.
– Bacterial culture – Samples are taken from around the nail to test for bacterial organisms.
– Blood tests – Systemic diseases and disorders can be detected with a complete blood count, metabolic panel, thyroid tests and more.
– X-rays – Help rule out broken bones or other causes of bruising/bleeding under nails.
– Nail bed biopsy – Removes a small nail sample to examine under a microscope.
Your doctor will consider your test results, medical history, and any medications you take to determine the likely cause. Once the underlying problem is identified, appropriate treatment can begin.
Treating Common Causes of Purple Nails
Here are some general guidelines for treating the most common causes of purple nail discoloration:
Bruising
– Rest and protect the injured nail from further trauma.
– Apply ice packs to reduce swelling and pain.
– Over-the-counter pain medication like acetaminophen or ibuprofen.
– The discoloration grows out with the nail over time as the bruise heals.
Fungal Infection
– Prescription antifungal lacquer or cream applied directly to the infected nail(s).
– Oral antifungal medication for more severe infections.
– Removing the infected part of the nail or complete nail plate.
– Applying over-the-counter antifungal treatments.
Bacterial Infection
– Oral or topical antibiotics prescribed by your doctor to treat the specific bacteria.
– Antiseptic soaks using products like Epsom salts.
– Keeping the nails trimmed and dry to prevent further infection.
Lack of Oxygen
– Treating any underlying medical conditions impairing oxygen circulation.
– Keeping fingers and toes warm to promote blood flow.
– Gentle exercises to improve circulation.
– Monitoring for signs of worsening problems.
Raynaud’s Phenomenon
– Keeping the body warm with gloves, socks and layered clothing.
– Medications that dilate blood vessels.
– Surgery in severe cases that don’t respond to other treatments.
– Avoiding triggers like emotional stress, cold weather, smoking, etc.
Medication Side Effects
– Switching to an alternative medication, if possible.
– Lowering the medication dosage, if approved by your doctor.
– Treating only the most affected nails for cosmetic reasons.
– Waiting for the discoloration to grow out after stopping the medication.
When to See a Doctor
See your doctor if purple nails do not go away within a couple weeks or keep recurring. Also get prompt medical care for:
– Discoloration combined with pain, swelling or pus.
– Changes in multiple nails at the same time.
– Known conditions like diabetes, lupus, or circulation disorders.
– Taking medications that can cause purple nails.
– Nails that start to separate from the nail bed.
– Fevers, chills or redness spreading from the nails.
These signs could indicate a more serious underlying problem that needs treatment. Leaving purple nails unchecked may allow an infection to worsen or a serious condition to go undiagnosed.
Caring for Purple Nails at Home
While waiting for purple discoloration to grow out or receiving treatment, you can help nails heal with:
Keep Nails Trimmed
Carefully trim nails to comfortable length to avoid cracked edges catching and causing more trauma. Use clean clippers and files.
Apply a Protective Clear Coat
A clear polish or protective gel helps hold the nail together and prevent debris from getting under the nail.
Use Topical Vitamin E
The antioxidants in vitamin E oil promotes healing. Gently rub over nails 1-2 times per day.
Take Oral Vitamin Supplements
Vitamin C, zinc, iron, and B vitamins support nail health and may speed up healing.
Watch for New or Worsening Symptoms
Monitor your nails and contact your doctor if symptoms persist or worsen despite home treatment.
Preventing Purple Nails in the Future
Once purple nails resolve, take steps to prevent a recurrence:
– Wear gloves for housework, gardening and cold weather.
– Treat nail fungal infections quickly to prevent spreading.
– Avoid picking at nails or biting nail tips.
– Moisturize cuticles and nails to keep healthy.
– Wear properly fitted shoes to avoid toe injuries.
– Quit smoking to improve circulation.
– Control chronic medical conditions like diabetes or autoimmune disorders.
– Change medications if side effects persist. Discuss options with your doctor.
When to Seek Emergency Care
Rarely, purple nails can indicate a true medical emergency requiring urgent care, such as:
– Purple nails accompanied by chest pain, shortness of breath and coughing up blood may be pulmonary embolism or pneumonia. Call 911.
– Sudden nail discoloration along with numbness and weakness on one side of the body could be stroke. Call 911.
– Very pale purplish nails plus dizziness and fainting may be heart attack or internal bleeding. Call 911.
– Purple nails after a traumatic limb injury may mean broken bones, extensive bleeding, or compartment syndrome. Seek emergency care immediately.
Do not wait with these signs. Call emergency services or get to an ER as soon as possible to receive lifesaving care if needed.
Conclusion
Purple nails usually aren’t an emergency on their own but still deserve a proper diagnosis. While bruising or cold temperatures may be harmless causes, purple nails could also indicate fungal or bacterial infections requiring treatment. Severe or widespread discoloration may signal an underlying health condition. See your doctor to determine the exact cause and appropriate care for purple nails. Quick treatment can help resolve the problem, relieve any discomfort, prevent complications like infections, and restore your nails to their healthy appearance.