Nail shape and texture can alter over time. Changes may result from repeated trauma, infections, skin conditions, nutritional factors, aging or systemic disease. The information below explains common patterns, when a clinician review is recommended, and typical evaluation steps. This page does not provide a diagnosis or personalized treatment. If you have severe pain, rapidly spreading infection, high fever, or sudden worsening, seek emergency care.
Nails can thicken, thin, pit, scoop (spooning), split, develop deep grooves (Beau lines) or otherwise deform. Frequent causes include repeated mechanical trauma, fungal infection (onychomycosis), dermatologic conditions such as psoriasis, systemic illnesses, nutritional deficiencies (for example iron deficiency), and occupational exposures. Normal aging also alters nail structure.
Pitting (small depressions) is commonly linked to psoriasis or alopecia areata. Spoon-shaped nails (koilonychia) can be associated with iron deficiency but are not diagnostic alone. Marked thickening often points to fungal infection or chronic trauma. Beau lines — transverse grooves across nails — can follow serious systemic illness or high fever. Changes in colour or texture require broader assessment.
If the change is mild and stable, primary care or dermatology can perform the first evaluation. Seek faster review when there is pain, discharge or bleeding from the nail bed, rapid progression of deformity, associated skin lesions, systemic symptoms (fever, unexplained weight loss), or when nail changes interfere with daily activities. For sudden severe symptoms, go to emergency services.
Evaluation begins with medical history and physical exam. Clinicians may take nail clippings or scrapings for microscopy and culture, use dermatoscopy to inspect nail structure, and order blood tests (CBC, ferritin, thyroid function) to look for systemic causes. Dermatology commonly leads assessment; infectious disease specialists may be involved for persistent fungal infections, and internal medicine or endocrinology if systemic disease is suspected.
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