If you’ve been diagnosed with systemic lupus erythematosus (SLE or lupus), you might make connections with ongoing health problems that weren’t apparent before. Longtime symptoms such as joint pain, mouth ulcers, hair loss, or rashes, may make more sense in light of a lupus diagnosis. Fingernail problems like nail ridges, splitting, and redness — which may appear differently depending on your skin tone — can also point to a lupus diagnosis.

Always talk with your rheumatologist if you develop any new or worsening symptoms that you believe may be related to your lupus. If you’re wondering about changes in your fingernails and lupus, here’s what you need to know.

What Do Nail Changes in Lupus Look Like?

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

“I’ve noticed horizontal ridges in all of my nails, or at least little dints in each of my nails."
— A MyLupusTeam member

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

For some people, nail involvement with lupus may cause significant concern. These nail issues can be painful or cause visible changes that might make you feel 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 reported swelling and redness in their nails. “Anyone have red/pink and slightly swollen skin around the nail?” a member asked. One member shared how fragile their nails had become: “I have lines on my nails, and they are very soft. They can’t grow because they constantly split, even with slight contact from clothing or other objects.”

“Anyone have red/pink and slightly swollen skin around the nail?” — A MyLupusTeam member

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 nail symptoms with lupus. 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 happen because of the inflammation and the way the immune system reacts to the condition. Lupus may affect the fingernails in several ways.

Lupus Lesions Around the Nails

Lupus lesions on the nail fold (the base of the nail where it grows from the finger) appear to be the source of many nail-related lupus problems, including ridges and splitting in the nail plate (the hard surface of the nail). Nail redness or redness/discoloration around the nails could be due to problems with blood vessels. Melanonychia (discoloration) may look purple, brown, or gray, depending on skin color.

Lupus Medications and Nail Changes

Side effects of lupus medications may also cause some of the nail abnormalities that people experience. Medications that affect the immune system may increase your risk of developing a fungal nail infection, damage to nail folds, or discolored nails. These include:

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

The antimalarial drug hydroxychloroquine (Plaquenil), which is commonly used to treat lupus, has also been linked to nail changes.

Biologic drugs, made from living cells to target the immune system, can increase the risk of fungal infections. Fungal nail infections can cause thickening and brittleness, as well as white, green, yellow, or black nails.

Professional Manicures and UV Light Exposure

Occasionally, some types of manicures can worsen 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 (sensitivity to sunlight).

Other Health Issues May Affect Nails

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

• Iron-deficiency anemia
• Thyroid problems
• Diabetes
• Pregnancy
• Malnutrition
• Melanoma
• Heart disease

About one-third of people with lupus also have Raynaud’s phenomenon (also called Raynaud’s syndrome). This condition develops as a result of other diseases such as lupus and can limit blood flow to your hands, causing skin color changes and fingernail issues like looseness, pitting, or grooves. Primary Raynaud’s phenomenon (also called Raynaud’s disease) can appear by itself, not secondary to another illness. In this case, the symptoms are more mild. 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, there are simple steps you can take to care for your nails. Keep reading to discover five helpful tips.

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 there’s water or moisture because fungal infections often start on the feet. A pair of flip-flops can help protect your toenails at pools, gyms, and locker room showers.
• Wear clean socks each day and, if possible, shoes made of canvas, mesh, or leather that don’t fit too tightly. This helps prevent the buildup of sweat and keeps your nails dry. Always let wet shoes dry before wearing them again.
• 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.
• Sanitize nail clippers and files before using them, and never share clippers, files, towels, or shoes, because fungal infections are contagious.

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. Some doctors recommend an anti-inflammatory diet rich in fruits and vegetables, whole grains, healthy proteins, and healthy fats.

Avoiding foods with saturated fats and reducing your intake of salt and sugar may help improve your nail health. These ingredients are often found in processed foods.

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 works 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.

Begin by applying moisturizer to your nails and the skin around them, including the cuticles every time you use lotion on 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. “All I can do is add nail fortifier to help keep them from splitting and chipping,” a MyLupusTeam member wrote.

5. Talk With a Health Care Provider

If you have ongoing 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.

Be sure to talk to your doctor before using a new product, such as a nail hardener, on damaged or sensitive nails.

Find Your Team Today

MyLupusTeam is the social network for people living with lupus and those who love and care for them. On MyLupusTeam, more than 233,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Are you struggling with nail problems related to lupus? Have you talked to your doctor about your nails or wonder how to take care of them? Share your experiences or start a conversation in the comments below or by posting on your Activities page.