White nails

What is a white nail?

Nail They are generally pink in color. A white nail describes the appearance of one or more fingernails and/or toenails that are partially or completely white in color. This appearance is also called leukonychia.

Classification of white nails

Total leukonychia is a whitening of the entire nail plate.

• Plush nails are white with reddened or dark tips.

Partial leukonychia has 3 subtypes:

• Stippled leukonychia: small white spots
• Longitudinal leukonychia: longitudinal band of white nail
• Striated or transverse leukonychia: one or more white horizontal bands across the entire nail parallel to the lunula, and are also called Mees lines.

Muehrcke's lines are a form of apparent transverse leukonychia due to variable blood flow under the nail; pressure on the nail plate makes them disappear. Vitiligo or leukoderma (white skin) may also cause apparent partial or longitudinal leukonychia.

Who gets a white nail?

White nails can affect anyone: men and women of any age or ethnicity.

What causes a white nail?

Trauma

The nail plate can be damaged in part or in whole by injuries to the nail plate or matrix (growth area at the base of the nail). Disruption of the horizontal layers of curb, with air trapping, results in reflection and lack of transparency.

Types of injuries that cause punctate leukonychia include nail biting, manicures, bumps and bruises, and tight footwear. The white spots grow as the nail grows (about 6 to 9 months for a nail). Striated leukonychia may follow damage to the nail matrix, and grooves and ridges may also appear on it. Total leukonychia may be followed by a more severe lesion, often with detachment of the nail plate from the nail bed and alteration of the nail contour.

Poisoning and drugs

White nails can be caused by:

• Heavy metal poisoning (e.g. lead, arsenic)
• Chemotherapy
• Sulfonamides.

Hereditary disorders

• Longitudinal leukonychia is sometimes associated with Darier disease, which can also cause erythronychia (a red band).
• Total leukonychia also sometimes runs in families.
• Striated leukonychia may be due to inherited conditions that affect keratinization.

Systemic disease

Plush nails have been associated with:

• Liver cirrhosis
• Chronic kidney disease
• Heart failure
• Protein malabsorption, e.g. Ex. in colitis
• protein losing enteropathy
• Diabetes
• Lack of iron anemia
• zinc deficiency
• Hyperthyroidism

Infection

Superficial white onychomycosis is an irregular type of partial leukonychia due to chronic fungal infection due to dermatophyte, Trichophyton interdigitale.

Skin illness

Leukonychia may be due to inflammatory skin disease affecting the nail matrix, most commonly nail or hand psoriasis eczema.

Differential diagnosis

Leukonychia must be distinguished from onycholysis, in which the nail plate appears white or yellowish because it has been lifted from the underlying nail bed.

Research

If the cause of leukonychia is unclear, the following tests may be helpful.

• Nail clippings for mycology
• A biopsy
• Blood tests to evaluate systemic disease. especially low albumin levels

What is the treatment for a white nail?

Treatment depends on the underlying cause of leukonychia.

What is the result for a white nail?

Leukonychia due to minor trauma or medication may resolve completely within a few months. In other cases, the white nail plate remains long-term or becomes recurrent.