Iron Deficiency & Nail Changes

Iron is one of the essential nutrients the body needs to function normally. The body uses iron to transport oxygen throughout the body, including to tissues and muscles, and to maintain cell growth and behavior. Iron deficiency deprives the cells in your body of oxygen, which can cause iron deficiency anemia. Changes in appearance of the fingernails can indicate serious medical conditions and diseases, such as iron deficiency.

A woman applying a polish to harden her nails. (Image: Alliance/iStock/Getty Images)

Iron Deficiency

The body needs iron to build and maintain red blood cells. You get iron through your diet. The body removes and replaces red blood cells regularly. When your body does not have enough iron, it makes fewer red blood cells or it makes red blood cells that are too small. Without sufficient iron, your body cannot move adequate oxygen to tissues and cells. Iron deficiency anemia occurs when your body does not make enough red blood cells or does not absorb iron well. Iron deficiency can also result from a diet low in iron, abnormal bleeding, or conditions that require your body to use more iron.

Diagnosis and Treatment

Changes in your nails may be the first indication that iron deficiency anemia might be a problem. If the anemia is mild, you might not have other symptoms. In time, you might experience weakness, fatigue, irritability, headaches and difficulty concentrating. The symptoms of untreated anemia include pale skin, shortness of breath, blue color in the whites of the eyes and brittle nails. Your doctor might order blood tests to detect iron deficiency and other examinations to determine the cause of the deficiency. Treatment includes treating the cause of the iron deficiency. You might need to take iron supplements or injections to replenish your body's iron. Your doctor might instruct you to add more iron-rich foods to your diet.


Changes to the texture, shape or thickness of nails that do not result from injury are nail growth abnormalities. Koilonychia is a nail abnormality that causes thin, inward curving nails with raised ridges on the surface. The nails have a flattened appearance and concavities, areas that appear indented. Koilonychia may be a symptom of iron deficiency anemia. Contact your doctor if you have koilonychia or other nail abnormalities that might indicate a medical problem.

Nail Care

Successful treatment of iron deficiency should correct koilonychia over time. Strengthen weakened or thin nails with clear nail polish that contains protein. The vitamin biotin can also strengthen nails. Some nail changes might indicate serious medical conditions. Contact your doctor if your nails are blue, clubbed, pale or if they have white lines, horizontal ridges or distortions. Inform your doctor if the color is white under the nails. Call your doctor immediately if you have splinter hemorrhages, which are narrow red or brown lines under the nails. The lines resemble splinters, and are associated with heart valve infection.

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