Your nails are a window into your overall health — any signs of splitting, ridges, or nail loss can point to an underlying health condition. People living with chronic graft-versus-host disease (GVHD) can experience nail changes along with other symptoms throughout the body. If left untreated, these symptoms can impact your day-to-day life, making simple tasks harder.

This article will discuss four symptoms of chronic GVHD affecting the nails and how they can impact your quality of life. We’ll also review how doctors treat nail abnormalities from GVHD, including prescription and over-the-counter remedies. Your care team can also offer tips and recommendations for managing other GVHD symptoms affecting nearby skin.

How Does Chronic GVHD Affect the Nails?

Chronic GVHD is a potential complication of receiving an allogeneic stem cell transplant. This medical procedure replaces diseased blood-forming cells with healthy ones from a donor. Also known as a bone marrow transplant, this treatment helps fight blood cancers, like lymphoma and leukemia.

In chronic GVHD, the donor cells mistake your body’s cells as foreign invaders, similar to how the immune system fights off bacteria or viruses. This immune response can damage various tissues, leading to symptoms affecting the nails, skin, and mouth.

Your fingernails and toenails are made of a hard protein called keratin. This substance is also found in your skin and hair. Your nails start growing at the nail root — an area of cells found under your cuticle. As new cells grow and flatten, they push the older nail forward, creating visible nail growth. The nail bed with blood vessels runs underneath your nail, supplying oxygen and nutrients.

Researchers believe that GVHD affects the nail matrix — the area where cells form new nail tissue. If the nail matrix becomes damaged, it struggles to repair itself or grow new tissue. This leads to visible nail changes like pitting, ridges, and even nail loss.

4 Symptoms of Chronic GVHD Affecting the Nails

Nail problems with chronic GVHD usually appear alongside skin symptoms. Keep track of any new changes you notice — they may be a sign that you need treatment for GVHD. Your doctor or a dermatology (skin) specialist can help.

1. Splitting and Ridging of the Nails

One sign of chronic GVHD affecting the nails is brittleness, which can lead to splitting or ridging. Ridges can develop vertically (longitudinal ridging) or horizontally across your nails. Horizontal lines, known as Beau’s lines, occur when nail growth is temporarily disrupted due to illness or systemic stress. Studies show that Beau’s lines also can develop in chronic GVHD. This is likely due to damage to the nail matrix.

2. Nail Loss

In some cases of chronic GVHD, nails can detach and fall off completely. This happens when the hard nail separates from the nail bed underneath. In addition, scarring along the nail bed may develop, which can affect future nail growth. Some people may lose a single nail, while others may experience multiple nail losses over time.

3. Abnormal Blood Vessels Around the Nail

Have you noticed tiny red lines along your cuticles where your nails grow? These are dilated blood vessels, a common sign of skin and nail GVHD. Not everyone will develop these changes, but when they do appear, they may be accompanied by other skin symptoms, such as color changes, thinning, or fragility of the skin.

4. Nail Infections

Paronychia (nail infection) can be another sign of chronic GVHD affecting the nails. When nails become thin or brittle, they can develop small cracks that allow bacteria to enter, often at the nail fold — the area where your nail meets the skin near the cuticle.

Signs of a nail infection include:

• Erythema (skin discoloration and warmth) – The skin around the nail may feel warmer than usual and appear red or pink on lighter skin and dark brown, purple, or gray on deeper skin tones.
• Tenderness, swelling, or pain
• Pus buildup – White or yellow fluid may collect under the nail.

To lower your chances of developing an infection, try to avoid biting your cuticles or nails, and keep your hands clean and moisturized.

Treating Chronic GVHD Nail Symptoms

If you’ve already been diagnosed with chronic GVHD, you’re likely getting treatment. These medications should help manage your nail symptoms. However, there are also other prescription and over-the-counter options available to provide some relief.

Topical and Systemic Treatments

Doctors may prescribe topical treatments that are applied directly onto the nail and surrounding skin. One commonly used medication is clobetasol, a corticosteroid (steroid) that helps reduce inflammation and discomfort caused by GVHD-related nail problems. Depending on your symptoms, your doctor may recommend:

• Clobetasol nail lacquer — A hard, polish-like coating that protects and stabilizes the nails
• Clobetasol ointment — Applied to both the nails and nearby skin to relieve inflammation and irritation

Other topical medications can offer some relief from nail and skin symptoms. Doctors usually prescribe immunosuppressant medications in ointments or creams. Examples include prednisone and tacrolimus (Protopic).

In some cases, doctors may recommend steroid injections directly into the nail fold. This can help treat inflammation where your new nail tissue grows. You’ll likely experience some pain with injections, but they work well for treating nail problems from GVHD.

If you take systemic (bodywide) treatments to relieve your chronic GVHD symptoms, such as oral medications (taken by mouth) or infusions, these should help improve your nail symptoms over time by controlling the underlying disease.

Over-the-Counter Remedies for Nail Problems

Weak, brittle nails can interfere with daily activity and negatively impact your quality of life. If your nails are breaking or falling off, you may struggle with gripping objects, typing, or buttoning clothes. To strengthen your nails, doctors often recommend over-the-counter options like nail lacquers and supplements. Applying a nail hardener two or three times a week may help protect your nails and prevent further damage.

Biotin is a type of vitamin B that plays an important role in energy production and keratin formation. A lack of biotin can also lead to brittle nails, skin rashes, and hair thinning. Some health experts suggest taking biotin supplements to help harden your nails. Before starting supplements, however, check with your healthcare provider. They can help you determine if supplements can help and guide you in choosing a reliable brand.

Caring for Split or Lost Nails

If your nails have split, wrap your finger or toe in a bandage. This will prevent any snagging and tearing on clothing or shoes.

Losing an entire fingernail or toenail can come as a shock. You’ll want to keep your hand or foot as clean as possible, as well as the surrounding area. It can take a week or more for the nail bed to heal and your new nail to start growing back. Keep an eye on your nail bed for signs of infection, and let your doctor know if you notice any new pain, swelling, or bleeding.

How Long Can It Take for Nails To Heal?

Health experts note that even with the right treatments, it can take several months for your nails to heal and regrow. Fingernails take around six months to fully grow, while toenails can take up to two years. Keep an eye on your nails closest to your cuticles. This is where the new tissue grows. If it looks strong and smooth, you’re on the right track for regrowing your nails.

Talk to Your Doctor About Your Nail Health

Living with chronic GVHD can significantly impact your life and overall health. It’s important to work closely with your healthcare team to properly diagnose and treat your symptoms. Studies show that nail problems with GVHD usually point to more severe problems with your eyes and mouth. Sticking to your treatment plan to control inflammation is key.

You’ll also want to let your doctor know if you begin experiencing any new side effects of your GVHD treatment. Topical medications can cause skin thinning and other complications.

Talk With Others Who Understand

On myGVHDteam, the site for people with graft-versus-host disease and their loved ones, people come together to ask questions, give advice, and share their stories with others who understand life with the condition.

Are you experiencing nail symptoms with GVHD? How has your medical team addressed them? Share your experience in the comments below.