Nails are dead structures made up of a protein known as keratin: the same which makes the hair. Commonly, the toenails and fingernails are pink in color with a crescent shape at the base of a nail. Medically known as leukonychia is a condition of the appearance of white spots on nails. Many healthy people have white spots on their nails, independent of their sex and age. It is not a sign of severe disease but is entirely harmless.
The white spots can appear on one nail or many more. It may be in the form of small dots, stretches, or can affect the entire nail. It refers to calcium deficiency in most cases. White spots on nails may be due to the injury in the matrix (base). Spots become visible on nails after 4-6 weeks of injury. In this post, you will learn what exactly these white spots are, its types, causes, and treatment.
Types of Leukonychia
Leukonychia can be total, sub-total, partial, longitudinal, or transverse. There are different types of leukonychia or white spots on nails. Each type has its different causes and varies in the severity of white discoloration on nails.
1) True Leukonychia
In true leukonychia, discoloration originates in the matrix and appears in the nail plate. It can be inherited or acquired: relates to zinc deficiency, systematic diseases, and heavy metal poisoning. Mees’ lines is a major type of true leukonychia.
Also known as Mees’ lines or transverse leukonychia is the appearance of single or multiple white bands or lines on the nail base. When the causes of true leukonychia are zinc or thallium intoxication, it is known as Mees’ lines. It can also develop on nails due to injury in the nail matrix and migrate along with the nail increases in size. Physical injuries leading to leukonychia striata are excessive manicure, bitting or tapping of nails, and injury from doors or windows. Or it may associate with many diseases or disorders like carbon poisoning, herpes zoster, cardiac failure, tuberculosis, Darier disease, or Hodgkin’s diseases.
2) Apparent Leukonychia
Apparent leukonychia affects the color of the nail plate and occurs when the nail bed is affected and the nail matrix is normal. To check whether you have apparent leukonychia press on the nail, if the white spot stays: it is not of major concern. But if the spots disappear or change color, it could indicate a serious health issue. Its causes are congestive heart failure, renal failure, diabetes, or nephrotic syndrome.
Further, there are three types of apparent leukonychia
- Lindsay’s Nails (Half and half nails): These nails are brown distally and are associated with chronic failure
- Terry’s Nails: It represents white spots with dark tips or reddened areas.
- Muehrcke’s nails: These are specific double white lines which do not disappear or move forward with time.
In pseudoleukonychia, the color of the nail plate is affected due to excessive use of solvents. There is a decrease in oil and moisture, and the white spots on nails appear due to solvent use.
It is not very common and is characterized by smaller longitudinal white lines of 1mm under the nail plate. Research shows that longitudinal leukonychia is a rare disorder that may occur due to deficiency of zinc or exposure to certain substances such as detergents or bleaching agents.
Causes of White Spots on Nails
There are different causes of white spots on nails from mild to extreme. Mostly it occurs due to injury, and the spot disappears as the nail grows. Various causes from food to trauma are as:
Injury to the matrix (growth area of the nail) nail plate or causes white spots on nails. When the air trapped in the horizontal layer of keratin, results in reflection, and the nail lacks transparency due to injury. Nail biting, tight footwear, and manicuring causes white spots. After these injuries, the spots grow as the nail grows as long as for six-nine months. Injury can be more severe in the case of total leukonychia by altering the color contour of the nail with a detachment of the nail plate.
Many types of leukonychia can be due to inherited or genetic diseases. But it is a very rare occurrence of nail diseases due to genetic causes. Darier disease can also be severe, causing a red band on the nail. Bart-Bumphrey syndrome, Bauer syndrome, and Buschkel-Gorlin syndrome cause various types of leukonychia. Total leukonychia and striate leukonychia can run in families.
Superficial fungus onychomycosis can penetrate the toenails, causing white spots on the nails. Nails can become thick and flaky when the infection spreads on the nails. Allergy due to nail polish or acrylic gels can also cause white spots on nails.
There are so many systematic illnesses that rarely become the cause of leukonychia. The illness shows that there is a problem in the body elsewhere. Anemia (iron deficiency) or calcium deficiency causes white spots on nails. Many other diseases like kidney failure, heart failure, eczema, diabetes, zinc deficiency, liver cirrhosis, psoriasis, and hyperthyroidism become its cause.
Heavy Metals and Drugs
Sometimes poisoning, medication, and drugs often lead to white spots on nails. Chemotherapy is a treatment for cancer given to the patient either by mouth or injection also causes leukonychia. Medication for bacterial infection and urinary tract, heavy metal poisoning, and sulphonamides relate to white spots.
Treatment of White Nails on Spot
Treatment depends upon what are the causes of white spots. If you visit a doctor, then he can recommend some tests to identify the disease like mycology, nail biopsy, and blood tests. There is no proper treatment for white spots caused due to injury. They are natural and will disappear over time. If you have an allergy, then immediately stop using nail polish or gloss. Antifungal treatment will be used when the cause is a fungal infection. But if you know that these spots are not by trauma or injury, you need to see a doctor. Not all the times the spots are normal it may be a signal or indication of severe health issues. If the spots are extreme or larger, seek medical assistance.