Leukonychia

Specialty: Skin.

• white spots on nails
• whitish nail discoloration
• white nails

Why it occurs

• punctate or traumatic striated leukonychia (repetitive microtrauma to the proximal nail matrix, commonly due to aggressive manicures or inappropriate footwear)
• Apparent leukonychia or Terry's nails (whitish discoloration of the proximal two-thirds of the nail with a distal pink band, secondary to advanced liver cirrhosis)
• Lindsay's nails or half-and-half leukonychia (white proximal portion and erythematous or brown distal portion, classic of advanced chronic kidney failure)
• Superficial fungal infection or superficial white ringworm (direct invasion of the external nail plate by dermatophytes)
• Severe systemic hypoalbuminemia (double transverse lines or Muehrcke lines).

Initial workup

Detailed physical examination to determine if the leukonychia is true (the white pigment is in the plate and does not lighten with pressure on the nail) or apparent (the pigment is in the nail bed and disappears when pressed on the nail). General analysis oriented: complete liver function profile, serum albumin, creatinine, urea nitrogen (BUN) and microbiological analysis of scrapings with PAS stain if superficial white mycosis is suspected.

Standard management

• Pharmacological therapy is not prescribed for benign traumatic leukonychias, limited to mechanical protection measures. The underlying systemic pathology is treated
• Ciclopirox in 8% nail polish — indicated if localized superficial white onychomycosis is clinically confirmed
• Dietary protein supplementation or albumin infusion — if there is severe hypoalbuminemia demonstrated in the laboratory
• Discontinue irritating cosmetic polishes or abrasive techniques on the cuticles.