Introduction Classification Demographics Causes Clinical features Variation in skin types Complications Diagnosis Differential diagnoses Treatment Prevention Outcome
A white nail, also known as leukonychia, is the partial or full discolouration of the nail plate on one or more fingernails or toenails.
White nails are the most common nail dyschromia. The nail will lose its general pink undertone and appear white.
Leukonychia can be classified by underlying pathology, its distribution, or how it develops.
Leukonychia can be subdivided into true and apparent discolouration.
Leukonychia can be partial or total.
White nails can be acquired or congenital.
White nails can affect anyone of any gender, age or ethnicity. Its presence may warrant a work-up for systemic disease.
Mees line, Lindsay nails, Muehrcke lines (see below), and punctate leukonychia may be associated with:
There are three distinct types of apparent leukonychia that may be associated with the systemic disease:
Terry nails have been associated with:
Lindsay nails have been associated with:
Muehrcke lines have been associated with:
True leukonychia with partial distribution:
Patients with multiple true leukonychia warrant a thorough history, physical examination, and medication review to exclude a toxic or systemic etiology. This is also true of leukonychia extending the full width of the nail plate.
They appear similar in different skin types.
White nails are a cosmetic nuisance but may be a marker of an underlying systemic disease, but per se do not have any physical complications.
A thorough history and physical examination may be sufficient for diagnosis. Although, when the cause is unclear, the following tests may be helpful:
Treatment ultimately depends on the presence of any underlying cause.
There is no treatment for trauma-related leukonychia. Punctate lesions will disappear as the nail follows its natural growth pattern (around 6 to 9 months for a fingernail).
Avoidance of trauma-induced leukonychia will help prevent development of white nails.
Leukonychia due to minor trauma or medication may completely resolve over a few months. In other cases, the white nail plate may remain permanently or demonstrate recurrence.
