Details: Category: Region 9; Published: 28 March 2022

Have you ever wondered why you have a white spot on your nails? Why do you have it? These white spots on nails are called Leukonychia. Leukonychia is a condition where white lines or dots appear on your finger or toenails. This is a very common issue and entirely harmless. Many healthy adults have these spots at some point in their lives, so developing them is likely not a sign of a serious medical condition. For some people, the white spots may appear as tiny dots speckled across the nail. For others, the white spots may be larger and stretch across the entire nail. The spots may affect one nail or several. Leukonychia is usually characterized by painless white spots that appear on the nails. The condition is more common on fingernails than on toenails, but it affects both. The degree of whiteness and discoloration depends on the type of leukonychia present.

Leukonychia is the most common chromatic abnormality of the nail however, the physiologic mechanisms causing it are not entirely clear and Newton's theorem (i.e. a surface appears white when it reflects the radiation of visible light), has been trying to explain leukonychia. In true leukonychia, there is abnormal matrix keratinization, with persistent parakeratosis and keratohyalin granules in the nail plate, which might play a role in the modification of the light reflection by the ungual plates. Baran classified leukonychia into the following 3 primary types: (1) true leukonychia, wherein the nail plate involvement originates in the matrix; (2) apparent leukonychia, in which the pathology lies in the subungual tissue; and (3) pseudo-leukonychia, which is due to keratin granulations, as seen in superficial white onychomycosis. Inherited leukonychia can be presented as an isolated condition or as one of the several other reported syndromes. There is an autosomal, dominantly inherited syndrome in which leukonychia occurs in combination with kidney stones and sebaceous cysts, with sensory-neural deafness and knuckle pads, which is known as the Bart-Pumphrey syndrome. Popular lay media claim that the etiology of leukonychia is due to calcium and/or zinc deficiency. However, no studies are available in the scientific literature to support or refute these claims. Acquired leukonychia has been reported due to trauma, drugs such as chemotherapeutic agents (e.g., anthracyclines, cyclophosphamide, vincristine, cyclosporine, fluorouracil, and methotrexate), and systemic or local infections (e.g., typhoid fever, hepatic cirrhosis, ulcerative colitis, leprosy, and recently due to selenium deficiency in Crohn's disease). In children, increased requirements for macro- and micronutrients during the growing years might not be met adequately through routine meals. This deficiency could not be reflected in their serum values; however, it could lead to subtle manifestations of nutritional deficiencies such as leukonychia, as in the present case. Clinicians should consider oral supplementation of relevant micronutrients in cases of acquired leukonychia, even in patients for whom serum levels do not reveal any evidence of nutritional deficiency.

For most people, white spots on your nails are nothing more than a bothersome spot. They are rarely signs of bigger problems, and most will disappear on their own without treatment.

If you’ve noticed white spots on your nails and wonder what to do, here’s a brief guide:

Think back and then protect your nails. Have you recently hit your nails or injured your fingers in any way? Are the spots on the affected digits? Protect your nails as best you can when doing anything where they may be pinched, hit, or smashed.
Take note of symptoms. Do you have any other symptoms, such as changes to your nail color or texture? Are your nails turning yellow or becoming brittle? You may need to see your doctor for treatment.
Talk with your doctor. If you think the white spots on your nails are not caused by injury, you can make an appointment with your doctor. After an examination, your doctor may offer a diagnosis and prescription.
Eat for better nail health. Eat a balanced diet and maintain adequate levels of vitamins to prevent side effects like white spots on your nails.

If you’ve noticed nail spots and are anxious about it, don’t worry. A quick visit to your doctor can help clear up whatever’s causing the spots and answer any additional questions you have. Most treatments are fast and effective.

NO I Zamubec Alomar C. Adlawan, RND

REFERENCES: