When people are diagnosed with systemic lupus erythematosus (SLE, often simply referred to as lupus), they often begin to make connections that hadn’t occurred to them before. Longtime health symptoms, such as joint pain, ulcers, hair loss, or rashes, may make more sense in light of a lupus diagnosis. Some people realize that fingernail and toenail problems, in particular, may be explained by their lupus diagnosis.

If you’re wondering about your nails and lupus, here’s what you need to know. As always, talk with your rheumatologist if you develop new or worsened symptoms that you believe may be related to your lupus, including changes to your fingernails or toenails.

What Do Nail Changes in Lupus Look Like?

Lupus can affect your fingernails in many ways. MyLupusTeam members have experienced a number of problems. “I’ve noticed horizontal ridges in all of my nails, or at least little dints in each of my nails,” shared one member.

Another member wrote that their “fingernails and toenails are starting to fall completely off,” while a third member asked, “Does anyone have problems with your fingernails separating from the nail bed?”

For some people, nail problems cause significant distress. They may be painful or include visible changes that cause you to become self-conscious. One member expressed concern about how their nails looked: “I am worried about my nails! They are turning a dark color near the tips and have developed horizontal ridges.”

Others have noticed lightened or white nail beds. “Does anyone have flattened fingertips? And white nail beds at times?”

Some MyLupusTeam members have also reported feelings of burning under the fingernails and on the fingertips. One member said, “I keep getting these red, raised bumps on my hands, mainly on my fingertips and fingers. They are painful and they burn.”

Sometimes, nail problems go away after a lupus diagnosis, most likely as the result of an effective treatment for the condition. Once your lupus is under control, nail problems may disappear. As one member explained, “For a couple of years after I was diagnosed with lupus, my fingernails did all kinds of weird things … ridges, wavy nails, and purple moons.”

Not everyone will experience these types of symptoms. However, treating lupus is one of the first steps toward getting nail problems under control.

How Lupus Affects the Fingernails

Nail changes in lupus likely occur as a result of the inflammation and immune response that characterize the condition. Lupus may affect the fingernails in several ways.

Lupus Lesions Around the Nails

Lupus lesions on the nail fold (where the nail grows from the finger) appear to be the source of many nail-related lupus problems, including ridges and splitting.

Lupus Medications

Side effects of medications for lupus may also cause some of the fingernail abnormalities that people experience. Medications that affect the immune system may increase your risk of getting a fungal nail infection or having discolored nails. These include:

• Corticosteroids (Prednisone)
• Azathioprine (Imuran)
• Methotrexate

Fungal nail infections can cause thickening and brittleness, as well as white, green, yellow, or black nails.

Occasionally, some types of manicures can worsen a person’s lupus and cause nail problems. Nail processes that involve exposure to ultraviolet light, such as gel manicures, can contribute to lesions around the nails and make lupus worse for some people with photosensitivity.

Other Health Issues

Nail problems may result from health issues other than lupus. These conditions include:

• Iron-deficiency anemia
• Thyroid problems
• Diabetes
• Pregnancy
• Malnutrition

About one-third of people with lupus also have Raynaud’s phenomenon (also called Raynaud’s syndrome or Raynaud’s disease). This condition is separate from lupus and can limit blood flow to your hands, causing fingernail issues like looseness, indents, or grooves. Your rheumatology team or dermatology provider will let you know if they think you have this condition and should pursue treatment.

How To Take Care of Your Fingernails When Living With Lupus

In addition to finding an effective treatment for lupus, you can take several steps to help manage related fingernail changes. Some strategies can be incorporated into your daily routine, and others may be particularly helpful when you are experiencing nail problems.

1. Take Action To Prevent Fungal Infections

Fungal infections may contribute to an altered nail appearance, alongside lupus itself. Following these tips can help prevent fungal nail infections from developing:

• Make sure your nails are clean. This is easier if you keep them short. Also do your best to keep your nails dry because fungus grows better in moist conditions.
• Avoid going barefoot in public places, especially where water or moisture is present because fungal infections often start on the feet. A pair of flip-flops can help protect your toenails at pools and gyms and in locker-room showers.
• Wear breathable socks and, if possible, shoes that allow air to pass through. This helps prevent the buildup of sweat and keeps your nails dry.
• If you get a fungal infection, treat it right away. Talk to your health care team — they may recommend over-the-counter products or prescribe antifungal treatments.
• Use separate nail care products (such as a nail clipper and files) for infected nails.

2. Eat Healthy Foods To Strengthen Your Nails

If you have lupus, eating well can give your body the nutrients it needs to build strong nails. Stronger nails resist cracking, breaking, peeling, and other problems.

There are various diet tips for people living with lupus, but the best diet for you is one you can stick with that offers a wide variety of nutrients. Some people recommend the Mediterranean diet, although that will work for you only if you like the included foods and commit to that eating style.

Any diet that encourages you to avoid most trans fatty acids and saturated fats and reduce your intake of salt and sugar may help improve your nail health. These ingredients are often found in processed foods, so look for whole or minimally processed foods like fruits, vegetables, and whole grains.

Some people with lupus find that they do better when avoiding certain foods, such as those containing gluten or dairy products. You may need to experiment to find out what will work for you. If you’re not sure where to start, talk to your rheumatology team. They may refer you to a specialist like a registered dietitian for advice on what to eat to help improve your nail health.

3. Reconsider Manicures and Pedicures

Manicures and pedicures can help you feel relaxed and cared for, which can be key to feeling better with lupus — but some substances used in professional manicures might cause nail problems and other symptoms of lupus. Additionally, if a manicurist nicks your cuticle, you might be at a higher risk of developing a fungal or bacterial infection.

You’ll need to find out what works best for you based on your nails and how you respond to certain manicures. You might choose acrylic nails, which don’t require exposure to UV light, or a basic moisturizing manicure that avoids nail lacquer and glue. If you’re unsure about what’s safe for you, ask your health care team for advice.

4. Treat Your Hands With Tender, Loving Care

Giving your hands some daily TLC may make lupus-related nail problems less likely.

Start by moisturizing your nails and around your nails (the cuticles) every time you smooth lotion onto your hands. Filing your nails instead of cutting them might help you avoid unnecessary nicks and scratches. You can wear gloves when washing dishes or cleaning your home so that you don’t expose your hands to extreme water temperatures or harsh chemicals.

A nail hardener or fortifying product might help strengthen weak nails. Some MyLupusTeam members use these products, such as one who wrote, “All I can do is add nail fortifier to help keep them from splitting and chipping.”

5. Talk With a Health Care Provider

If you have repeated nail problems related to lupus and can’t get them under control, seek medical advice from your doctor or a dermatologist. Some therapies or treatment options might be available only by prescription.

Find Your Lupus Team Today

MyLupusTeam is the social network for people living with lupus and those who love and care for them. Here, more than 225,000 members come together to share their stories, ask and answer questions, and engage in conversations. Before long, you’ll meet people and form a team that will stay beside you no matter what happens with lupus.

Are you struggling with fingernail or toenail problems related to lupus? Do you worry about your nails or wonder how to take care of them? Share your questions or thoughts in the comments below or by posting on your Activities page.