Many MyMSTeam members have wondered about changes to their fingernails after their multiple sclerosis (MS) diagnosis. Some wonder whether MS itself might be affecting their nails, while others look for different explanations for changes in nail appearance or growth.

In this article, we’ll consider member anecdotes and research on how MS might affect fingernails. If you think you may be experiencing nail changes as a symptom of MS, talk to a healthcare provider. They can help determine the cause and work with you to find the best way to manage it.

Can MS Cause Changes to the Fingernails?

While nail changes are not widely recognized as a direct symptom of MS, many MyMSTeam members have noticed nail changes after their MS diagnoses. As one member wrote, “I have grooves in my fingernails and toenails.”

Another described their fingernails as “dry and brittle.”

A third asked, “Anyone else get flat spots on their fingernails? I haven’t always had them, and only noticed after I was diagnosed.”

One member said their healthcare provider regularly checks their nails for changes: “The doctor always looks at my fingernails. I brought the ridges up, and he said that a lot of people with autoimmune diseases seem to have them.”

There doesn’t appear to be a confirmed link between MS and most of the nail issues members describe. However, some research suggests that people living with MS may be more likely to experience certain types of nail changes.

Fungal Infections

Onychomycosis is a fungal infection and a nail disorder that can affect the fingernails. This fungal infection may cause the nails to become thick, separate from the nail bed, and appear discolored. According to one study, onychomycosis is slightly more common in people diagnosed with MS than it is in the general population.

Because the study sample was relatively small and the increase in fungal nail infections was minimal (32 percent vs. 26 percent), researchers recognize that more work needs to be done to confirm this connection. Still, it may be worth asking your doctor about a possible fungal infection if you notice nail changes like thickening, discoloration, or separation. In most cases, onychomycosis can be treated with antifungal medications.

Side Effects of MS Medication

One medication often prescribed to treat MS, teriflunomide (Aubagio), has been reported to cause changes to the fingernails in some case reports. Specifically, in one case, teriflunomide was thought to have caused fingernails to develop psoriasiform nail changes — that is, changes that resemble symptoms of the inflammatory skin condition psoriasis.

People with these changes may develop fingernails that appear thicker than usual, discolored and scaly, and inflamed. A person who experiences these nail changes may need to be evaluated for psoriasis to make sure they haven’t developed this condition.

In addition, side effects listed for teriflunomide include causing psoriasis in some people. Thus, a dermatologist may be needed to differentiate between a person with MS whose hands have symptoms similar to psoriasis and someone who has actually developed psoriasis.

Another case described total nail loss after teriflunomide, which was reversible. The nail grew back after the person discontinued the medication.

If you experience these side effects, it’s best to consult with a healthcare provider. Talk to your neurologist about treatment options before making any changes to disease-modifying therapies (DMTs).

Learn more about switching MS treatments.

What Else Could Cause Fingernail Changes in People With Multiple Sclerosis?

Some nail changes are a normal part of aging. As people age, nails often become thicker, duller, or more ridged. So, any changes you notice might not be cause for concern.

However, nail changes can sometimes signal problems elsewhere in the body. If you’re living with MS and notice new or unusual changes in your fingernails, talk to your primary care doctor or neurologist. They may refer you to a healthcare provider specializing in dermatology. In some cases, nail changes may point to a comorbidity (a second, unrelated medical condition) that should be evaluated and treated promptly.

Beau’s Lines

Beau’s lines are horizontal indentations that go all or most of the way across a fingernail. These lines most commonly occur when nail growth at the cuticle occurs at the same time the finger is injured or during a severe illness.

However, these lines can also indicate:

• Diabetes that is not under control
• A recent high fever from an illness such as pneumonia
• Vascular problems in the finger and the nail
• A thyroid issue or thyroid disease

People with MS may occasionally experience Beau’s lines after a flare-up, though they should get checked for these other conditions, as well.

Nail Pitting

Some people who experience nail pitting say it looks like someone chipped away at their nails with a tiny ice pick. This nail symptom is most common in people diagnosed with psoriasis. However, nail pitting can also indicate autoimmune disorders, such as alopecia areata and reactive arthritis (previously known as Reiter’s syndrome).

While there’s no literature connecting MS to either of these immune system disorders (beyond a single case of alopecia areata), it’s best to get evaluated for them if your nails have pits. Nail pitting is also a common symptom of another autoimmune disorder, psoriatic arthritis.

MS can be complicated by other autoimmune conditions, so it’s best to schedule an appointment with your healthcare provider as soon as possible. They can help you figure out what’s going on and discuss possible treatment options.

Nail Ridges

Nail ridges are similar to Beau’s lines but instead run up and down the length of the nail rather than across it. These ridges may indicate:

• Rheumatoid arthritis
• An injury to the nail
• A nutritional deficiency of folic acid, protein, or iron

People with MS may be at a higher risk of developing rheumatoid arthritis, so they should consult a doctor to rule this condition out first. After that, a registered dietitian may be needed to evaluate their diet and make sure they are getting enough folic acid, protein, and iron.

Yellow Nail Syndrome

Sometimes, fingernails appear to turn yellow. This discoloration usually happens when the nails grow more slowly than normal and grow thicker rather than longer. Yellow nail syndrome can be a side effect of swollen hands or indicate a respiratory disease.

Yellow nails may also indicate a fungal infection, like onychomycosis. In extreme cases, yellow nails can indicate liver disease, but it’s unlikely that a person would not already know they had liver disease before their nails turned yellow.

Separated Nails

The separation or detachment of nails from the nail bed is referred to as onycholysis. Onycholysis can be a symptom of a fungal infection, but it can also stem from other causes. Nail separation can be associated with conditions including:

• Lung disease
• Leukemia
• A vitamin C deficiency
• Lupus
• Lung cancer

However, nail separation usually doesn’t mean there’s a serious health problem. if you have MS and notice this symptom, it’s a good idea to have a doctor check it, just to be safe.

Find Your Team

On MyMSTeam, the social network for people diagnosed with MS and those who love and care for them, members come together to ask questions, give advice, and share their experiences with others who understand.

Have you experienced fingernail changes with MS? Share your thoughts in the comments below or by posting to your Activities feed.