What are Terry’s nails?

Terry’s nails are a specific nail abnormality that can be a sign of an underlying medical condition. They are characterized by the proximal two thirds of the nail being white with distal one third of the nail being dark or red.

What causes Terry’s nails?

There are a few potential causes of Terry’s nails:

  • Liver disease – Terry’s nails are most commonly associated with liver conditions such as cirrhosis or chronic hepatitis. The abnormality is thought to be related to a decrease in vascularity and blood supply to the nail bed.
  • Diabetes – Poor circulation and vascular changes related to diabetes can also lead to the development of Terry’s nails. The nails may be a sign of advanced diabetes or diabetic kidney disease.
  • Congestive heart failure – Heart conditions that affect circulation may result in Terry’s nail changes. Backup of blood and fluid in congestive heart failure impacts nail bed blood flow.
  • Thyroid disorders – Both hyperthyroidism and hypothyroidism have been linked to Terry’s nails. Thyroid issues can disrupt normal nail growth.
  • Malnutrition – A severe deficiency of protein, zinc, or other nutrients may cause the white discoloration seen with Terry’s nails. Malnutrition impacts nail growth and integrity.
  • Aging – As people age, nails tend to become thinner and lose vascularity. This can lead to the changes seen with Terry’s nails in older individuals.

What does it mean if I have Terry’s nails?

If you notice that your nails have taken on the characteristic appearance of Terry’s nails, it is important to see your doctor. While Terry’s nails themselves are not dangerous, they can be a clue that an underlying medical issue may need attention. Your doctor can help determine the cause and appropriate treatment.

Some key points about the potential meaning of Terry’s nails:

  • The most common cause is liver disease – Over 50% of cases are related to underlying liver conditions like cirrhosis or hepatitis.
  • It can signify diabetes complications – Terry’s nails may be a sign of advanced diabetes, particularly diabetic kidney disease.
  • Heart and circulation issues may be present – Terry’s nails can indicate problems with blood flow due to heart failure, peripheral vascular disease, or other circulatory system conditions.
  • Nutrient deficiencies may be contributing – Severe malnutrition related to deficiencies of protein, zinc, or other nutrients may manifest as Terry’s nails.
  • May reflect aging processes – Thinning nails and reduced blood supply due to aging can result in Terry’s nail changes in older individuals.
  • Cancer is a rare cause – In a very small percentage of cases, Terry’s nails may be associated with cancers involving the liver, kidneys or lungs.
  • An underlying disorder needs evaluation – The nails themselves don’t cause issues, but reflect disease processes that need medical assessment.

What do Terry’s nails look like?

Terry’s nails have a very distinct appearance that your doctor can recognize immediately. The hallmark features of Terry’s nails include:

  • White proximal nails – The proximal two thirds of the nails are white or pale pink in color. The whiteness starts from the nail root and extends to near the nail tip.
  • Dark distal nails – The nail bed near the tip takes on a darker reddish-brown or black discoloration. This is most noticeable on the big (1st) and little (5th) fingernails.
  • Nail bed changes – The cuticle and surrounding nail bed often appear abnormal, with some cyanosis (bluish discoloration) or dilation of small vessels.
  • All nails affected – The abnormality affects all nails, including fingernails and toenails on both hands and feet.

The proximal pale nails with darker free edge gives the appearance of “painted nails” which should trigger suspicion for Terry’s nails. Some people may also develop longitudinal ridging, over-curvature, or become thickened or brittle.

How are Terry’s nails diagnosed?

Terry’s nails are usually diagnosed just by visual examination of the nail appearance. Your doctor can readily recognize the characteristic features. Testing is focused on identifying an underlying cause:

  • Physical exam – Exam of other body systems may reveal signs of liver disease, heart failure, diabetes complications, or poor health.
  • Blood tests – Blood work to evaluate liver and kidney function, check glucose, test thyroid levels, look for nutrient deficiencies, and assess overall health.
  • Urinalysis – Testing the urine can provide clues related to potential kidney issues or diabetes.
  • Imaging tests – If liver disease is suspected, your doctor may order imaging like an abdominal ultrasound, CT scan, or MRI to visualize the liver.
  • Nail biopsy – Rarely needed, but a biopsy of the nail matrix may be done to examine tissue under a microscope.

The testing guides treatment of any underlying medical problem contributing to the nail changes of Terry’s nails.

Can Terry’s nails be cured?

There is no cure specifically for Terry’s nails. The nail discoloration and changes are a manifestation of an underlying disorder:

  • Treatment focuses on identifying and managing any associated condition, such as liver disease, kidney failure, diabetes, hypothyroidism, or malnutrition.
  • With appropriate treatment of an underlying disease, the Terry’s nails may gradually normalize and regain a more healthy appearance.
  • For example, in a patient with congestive heart failure, optimizing heart medications and controlling fluid retention can improve circulation and blood flow to the nail bed.
  • If the Terry’s nails are related to aging changes, there is no specific cure, but nails can be kept trimmed to minimize the appearance.
  • In some cases, the nails remain permanently discolored despite therapy of an associated disorder.

Talk to your doctor about targeting any underlying illness or deficiency state that could be contributing to the development of Terry’s nails.

What is the treatment for Terry’s nails?

Again, there is no treatment only for the nail changes seen with Terry’s nails. The goal is to identify and treat any associated medical condition that may be causing the nails to appear this way. Some general treatment considerations:

  • Chronic liver disease – This may require medications, abstaining from alcohol, weight loss, or rarely a liver transplant.
  • Diabetes – Improving blood sugar control through diet, exercise, medication, insulin, or surveillance for diabetic complications.
  • Heart failure – Medications to improve heart function, treat fluid overload, and optimize circulation.
  • Hypothyroidism – Thyroid hormone replacement medication.
  • Kidney failure – Dialysis or kidney transplant if kidney function is very poor.
  • Malnutrition – Diet modification or vitamin/nutrient supplements.
  • Aging – No specific treatment, but keeping nails groomed.

Lifestyle measures like eating a healthy diet, exercising, stopping smoking, and limiting alcohol intake may also be recommended. Follow your doctor’s advice for screening and management of any disorders linked to your Terry’s nails.

What are the complications of Terry’s nails?

Terry’s nails themselves do not cause complications or pose any health risks. However, the underlying medical conditions that lead to their development can have complications if left untreated:

  • Cirrhosis can lead to liver failure, bleeding issues, fluid retention, and increase the risk of liver cancer.
  • Uncontrolled diabetes increases the risk of eye, kidney, nerve, and heart damage.
  • Congestive heart failure can worsen, leading to pulmonary edema, reduced cardiac output, and heart rhythm abnormalities.
  • Kidney disease progresses to kidney failure requiring dialysis or transplant.
  • Hypothyroidism may worsen fatigue, weight gain, depression, cognitive impairment, and cardiovascular health.
  • Malnutrition poses many adverse effects including immunodeficiency, muscle wasting, neurological symptoms, and death.

The development of Terry’s nails should prompt investigation for any associated conditions, as failure to treat them can result in harmful complications.

What is the prognosis for someone with Terry’s nails?

The prognosis for someone with Terry’s nails depends entirely on the underlying cause:

  • With appropriate treatment, many of the associated disorders can be well-managed and life expectancy may be unaffected.
  • If the Terry’s nails are due to aging changes, they pose no health risk and do not impact lifespan.
  • If linked to an irreversible condition like advanced liver disease, the prognosis relates to the associated disorder which may ultimately shorten life expectancy if it cannot be treated.
  • Terry’s nails due to diabetes, thyroid disorders, malnutrition, or heart problems often resolve if the related disease is successfully managed.

There are also some cases where Terry’s nails resolve on their own even if a related disease persists. Overall, the nails themselves do not influence the prognosis – it is the associated medical conditions that impact health outcomes.

Can children get Terry’s nails?

Terry’s nails are rarely seen in children, but they can sometimes occur if:

  • The child has advanced liver disease, such as from biliary atresia or cirrhosis from a genetic metabolic disorder.
  • The child has type 1 diabetes with kidney involvement.
  • There is an underlying congenital heart defect leading to chronic heart failure.
  • A major malnutrition state or nutrient deficiency is present.
  • Certain chronic kidney diseases affect nail bed circulation and growth.

Since many of the causes relate to chronic disease, Terry’s nails tend to affect adults more than children. But persistent discolored nails in a child need medical evaluation to determine if disease or malnutrition is contributing.

Are Terry’s nails contagious?

No, Terry’s nails cannot spread between people. Since they relate to internal disease processes, the condition itself is not contagious. Some key points:

  • There is no risk of catching Terry’s nails from another person or passing it to someone else.
  • The nail changes result from the person’s own underlying medical disorder.
  • Diseases associated with Terry’s nails like liver disease, diabetes, and heart failure are also not spread by casual contact.
  • Family members may both have Terry’s nails, but this would relate to a shared genetic disease or environmental factor.
  • The sole exception is malnutrition, which can impact whole groups of people with nutritional deficiencies.

Rest assured that Terry’s nails are not transmissible through everyday contact. The nail appearance results from internal physiologic disease processes.

Are Terry’s nails preventable?

There is no definitive way to prevent Terry’s nails from occurring, since they arise due to underlying disease states. However, steps can be taken to minimize risk factors that contribute to their development:

  • Eat a healthy diet and avoid malnutrition to reduce risk of nutrient deficiencies.
  • Maintain normal blood sugar through diet, exercise, and medication if needed to prevent uncontrolled diabetes.
  • Limit alcohol intake and avoid toxins to support normal liver function.
  • Treat hypothyroidism to avoid changes from thyroid imbalance.
  • Control blood pressure and cholesterol to maintain heart health.
  • Stop cigarette smoking which can impair circulation.
  • Monitor for diseases like diabetes through regular screening exams.

While not guaranteed to prevent Terry’s nails, optimizing your overall health is important. Be sure to see a doctor if nail discoloration does develop.

Can Terry’s nails be permanent?

In some cases, yes the changes of Terry’s nails can be permanent. However, there are also many instances where the nails return to a more normal appearance with treatment:

  • If due to aging changes, the pale nails with darker tips will persist given the irreversible nature of this process.
  • With chronic incurable diseases like cirrhosis, the nails generally remain permanently discolored.
  • When linked to well-managed conditions like heart failure or diabetes, the Terry’s nails may resolve over time.
  • Malnutrition-related Terry’s nails typically improve with vitamin supplementation and diet changes.
  • Even without a cure for the underlying disorder, some cases resolve spontaneously.
  • Discuss your prognosis with your doctor to understand likelihood of permanence.

In summary, Terry’s nails can be permanent but may also normalize. The outlook relates to whether the associated disorder can be successfully treated.

Do Terry’s nails go away?

In many cases Terry’s nails do gradually go away, if the underlying condition improves. However, they may persist indefinitely in other circumstances:

  • Most commonly go away if the associated disease process is treated, like diabetes or hypothyroidism.
  • May disappear over time if due to transient malnutrition.
  • Can resolve if related to medication side effects, when the medication is stopped.
  • May go away spontaneously even with no treatment of an underlying condition.
  • Typically do not resolve if the nails are due to irreversible liver disease or aging.
  • Have a variable prognosis with advanced kidney or heart disease.

Monitor your nails after diagnosis and treatment of any associated disorders. Point out changes to your doctor at follow-up visits. Full normalization may take 12-18 months but indicates recovering health.


Terry’s nails are characterized by the appearance of white nails proximally and darker nails distally and are associated with certain medical conditions. While not dangerous in and of themselves, they can be an important clue signaling liver disease, diabetes, heart problems, malnutrition, or other disorders. Evaluation for underlying conditions is recommended if Terry’s nails develop. In many cases the nails will gradually normalize with successful disease treatment, but they may remain permanently discolored in some circumstances depending on the prognosis. Being aware of Terry’s nails helps ensure any potentially serious associated illness gets diagnosed and managed. Consult a doctor for proper assessment and monitoring if you notice these characteristic nail changes.

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