His Fingernails Were Purple but Didn’t Hurt. What Was This?

She greeted the patient cheerfully, then took a long look at his nails. They weren’t purple but dark gray or black. And the coloring wasn’t even. It had a kind of grainy look to it. The cuticle wasn’t involved, nor was the nail fold just beyond.

One common cause of discolored nails is medications. Years ago, gold was used to treat rheumatoid arthritis. It can cause a bluish pigmentation of the skin and sometimes the nails. Had he ever been treated with gold? Never, he stated flatly. What about silver? That is sometimes added to supplements people buy off the internet. He never used supplements. There are other drugs that can do this — most common are antibiotics, especially members of the tetracycline family — but the patient wasn’t taking any of these. Heavy metals like arsenic, lead or mercury can also cause nail discoloration. But the man looked far too healthy to have an exposure to this type of toxin sufficient to cause these findings.

A Closer Look

The doctor noticed that it was only the fingers that were involved; the nails on the thumbs were normal. To the dermatologist, that, and its grainy appearance, suggested that the discoloration came from the outside rather than the inside. She picked up her dermatoscope — a kind of souped-up magnifying glass with a strong built-in light designed to evaluate pigmented lesions on the skin. Looking closely at the nail, she could see that the expanse of color was actually created by hundreds of tiny black granules on the outer surface of the nail and not within the nail itself. She asked him about his hobbies. Did he paint or work with his hands? Nope. Just Pickleball. She’d seen people with this kind of discoloration on their fingers from reading the newspaper, but never on the nails.

Suddenly she asked, “Does your wife color her hair?” She did, the man told her. “Do you ever help her?” Never. She would never let him, he said with a smile. It didn’t look as if the man dyed his hair — it was graying. She was quiet for a minute. “I have been using a new shampoo,” the man offered. He was at the drugstore and saw a shampoo that said that it could get rid of the gray and restore natural hair color. His son was getting married in the fall, and he thought it would be nice if he had his old hair color back. “But it’s not a dye,” he insisted. Besides, he added, it didn’t work.

Show me how you shampoo your hair, Burnett asked. The man began massaging his scalp, using all four fingers on each hand, but neither thumb. Certain of her diagnosis, Burnett pulled out a little packet from a drawer. When she tore it open, the man recognized the smell of acetone: nail-polish remover. The dermatologist briskly rubbed a nail, and almost instantly the gray discoloration came off, leaving the nail close to its original color.

The product he used, Just for Men Control GX Grey Reducing Shampoo, doesn’t use the word dye in its advertising or packaging. In the company’s promotional material, it says that the product “mimics the universal pigment held within a strand of hair to create every person’s natural hair color. It gradually restores pigment to gray hairs with each use.” The material suggests that this is some natural process they’ve tapped into. In fact, it’s a dye hidden inside a shampoo.

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