What Causes Uneven or Irregular Toenails?

In daily life, uneven or irregular toenails require targeted treatment based on the underlying cause of this symptom. So, what causes uneven toenails?

What Causes Uneven Toenails?

Uneven toenails may result from several possible causes. Onychomycosis (fungal nail infection) can lead to surface irregularities after fungal invasion. Nail involvement in eczema or lichen planus-like changes may also cause localized unevenness. Patients with psoriasis often develop nail abnormalities, including pitting and uneven nail surfaces. Additionally, malnutrition may contribute to such nail irregularities.

When uneven toenails occur, a fungal examination is essential. If fungi or fungal spores are detected, the diagnosis is confirmed as onychomycosis (“tinea unguium”), requiring antifungal therapy. Oral antifungal agents—such as itraconazole or terbinafine—may be prescribed. However, if the patient has abnormal liver function, topical antifungal therapy is preferred. If fungal testing yields negative results, the condition is likely nail dystrophy (nail nutritional deficiency). In such cases, topical application of medications like polysulfated mucopolysaccharide cream may be appropriate, depending on the individual’s clinical presentation.

If you notice uneven toenails, it is crucial to consult a dermatologist in person for accurate diagnosis and identification of the underlying cause. Only then can appropriate, cause-specific treatment be initiated—minimizing risks of misdiagnosis or missed diagnosis. We hope this information is helpful to you.