Nail changes and infections

Nail changes are common and can affect fingernails or toenails. Changes in colour, thickness, or shape may be due to infection, skin conditions, injury, or underlying health issues. While many nail problems are harmless, some require assessment and treatment.

This page explains common nail changes, causes, and when to seek GP advice.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help with skin concerns, please book an appointment. We also offer specialist GP dermatology input at the Skin Clinic.

Skin Clinic

Common nail changes and symptoms

SNail problems may present as:

Thickened or brittle nails
Yellow, white, or discoloured nails
Crumbly or distorted nail edges
Separation of the nail from the nail bed
Pitting or ridging of the nail surface
Pain or redness around the nail

Toenails are more commonly affected by infection than fingernails.

Common causes of nail changes

Fungal nail infection

Fungal infections are a common cause of thickened, discoloured, or crumbly nails. They often develop slowly and may follow athlete’s foot.

Nail psoriasis

Psoriasis can affect the nails, causing pitting, thickening, discoloration, or separation from the nail bed.

Trauma or pressure

Repeated injury or pressure, particularly to toenails, can cause thickening, colour changes, or nail loss.

Other causes

Nail changes may also be linked to:

Eczema or dermatitis around the nail
Bacterial infection
Underlying medical conditions
Age related nail changes

Correct diagnosis is important, as treatments vary.

How a GP assesses nail problems

A GP will assess nail problems by reviewing symptoms and examining the nails. They may ask about:

Duration and progression of nail changes
Involvement of one or multiple nails
Associated skin conditions
History of trauma or pressure
Previous treatments

Photographs are often helpful for remote assessment.

Investigations

Nail sampling may be recommended if a fungal infection is suspected, particularly before starting long term treatment.

Blood tests are not usually required unless another underlying condition is suspected.

Self care and nail care measures

Good nail care can help prevent worsening:

Keep nails trimmed and clean
Avoid sharing nail clippers or tools
Keep feet dry and change socks regularly
Wear well fitting footwear
Avoid nail cosmetics during treatment

Nail changes often take months to improve as nails grow slowly.

Medical treatments a GP may recommend

Treatment depends on the underlying cause. A GP may recommend:

Antifungal treatments for confirmed fungal infection
Topical treatments for nail psoriasis or dermatitis
Advice on footwear and nail care
Referral if diagnosis is uncertain or treatment fails

Treatment response can take several months.

When to seek GP review

You should consider a GP appointment if:

Nail changes are persistent or worsening
You notice an unusual appearance or colour to your nails
Multiple nails are affected
Nails are painful or infected
Over the counter treatments are not helping
You are unsure of the cause

Early review helps guide appropriate treatment.