Do you ever wonder what white spots on your nails mean? These white dots that are randomly spread on your nails have multiple causes of occurrence behind them and can lead to the severity of not being diagnosed and treated timely. Let us discuss what these white spots actually are, how are they caused, and what are the steps for their diagnosis and treatment.
Leukonychia
The appearance of white spots on nails is termed leukonychia, a condition that can affect individuals of every age group. Apart from the dots, white lines may also be observed in some patients.
Leukonychia-affected nails
The condition is classified based on the extent of the affected area as well as the nature of it. Thus the following categories are formed:
Classification based on the extent of the affected area
- Total leukonychia
Total leukonychia is a condition in which all 20 nails become completely white.
- Partial leukonychia
In partial leukonychia, a small portion of the nail is affected. Moreover, it may only be confined to one or more nails but not completely affect all of them.
Classification based on the nature of the affected area
- True leukonychia
True leukonychia is a condition that has its origin in the nail matrix which is considered the root of a nail and is responsible for the formation and elongation of new nail cells.
- Apparent leukonychia
In apparent leukonychia, the area underlying the actual nail called the nail bed, is affected. In this condition, the actual nail remains protected.
It is mostly associated with various deficiencies in the body the most prominent of which is the low levels of calcium but there is more to that observation. There exists a multiplicity of factors causing these white dots on nails. Let us look into them in detail.
- Injury to the nail matrix
The presence of white marks on nails is, first and foremost, associated with an injury that has affected the matrix of the nail. These include:
- Pressure is applied onto the nail by the tools used during a manicure
- Pressure is applied on a nail due to hitting a hard surface such as a desk, a wall, a countertop, etc.
- Injury due to a hammer
- Injury due to shutting a finger in the door hinges
A nail injury
- Deficiency of certain minerals
Minerals that are important for healthier nails, when become deficient, can cause white spots on nails. Two of these major minerals are:
- Calcium
- Zinc
- Contracting a fungal infection
Fungal spores can also be responsible for the initiation of an infection in the nails. In this regard, a fungus named ‘white superficial onychomycosis’ causes white spots on toenails. If the infection spreads, the toenails may become weak, and flaky, and leave their base. Consequently, the nails may become brittle and may also start falling.
- Allergic reaction
An allergy to a chemical agent can be the cause of the appearance of white dots on nails. These chemical moieties include:
- Nail paint
- Acrylic nails
- Gel nails
- Nail polish remover
- Gloss
- Nail hardener
Nail polish acting as an allergen to some individuals
- Hereditary causes
Although it is rare, one can inherit true leukonychia. Such an individual will carry a mutated gene transmitted from their parents. At birth, these individuals will express totally white nails which is an indication for the diagnosis of true leukonychia. However, in some cases, these white fingernails may also indicate the presence of certain diseases such as:
- Darier disease: Darier disease is a health state associated with the presence of wart-like blemishes along with nail problems.
- Buschkell-Gorlin syndrome: It is a condition responsible for the development of kidney problems, cysts on the skin, as well as nail issues.
- Bauer syndrome: It is particularly associated with damaged nails and skin.
- Bart-Pumphery syndrome: It is associated with the manifestation of nail and knuckle issues along with hearing abnormalities.
- Ingestion of chemical agents
The use of certain medications may become a cause of nail abnormalities. These drugs include:
- Antibiotics i.e. Sulfonamides
- Chemotherapeutic agents
Moreover, heavy metal poisoning is also one of the leading causes of nail damage as they affect the nail plate. These metallic entities include:
- Lead
- Arsenic
- Skin diseases
Some skin diseases can progress and start affecting the nail plate. This weakens the nail root and white lines or dots start appearing on the nails. These conditions include:
- Nail psoriasis
- Hand eczema
- Leukoderma
Furthermore, the presence of diseases such as cirrhosis of the liver, hyperthyroidism, anemia, pneumonia, diabetes, as well as other kidney or heart diseases can also serve as a base for the deterioration of nail health.
How to diagnose leukonychia?
If you are wondering, ‘What are the white spots on my nails and what is their cause?’, you should consult your doctor who might want to look for:
- A simple discussion about your medical history can tell if you are taking certain medications which are affecting your nail health.
- Signs of an injury are evaluated first.
- Biopsy of your nail can also be done in which a tissue sample from the nail base is analyzed under a microscope.
- Mycological testing can be done in which the doctor may collect your nail sample and send it for examination to look for fungal spores.
- Blood tests can also be run to check if the blood has a higher level of heavy metals. Additionally, other tests may also be recommended to check if you have any other disease which is indirectly affecting your nails.
Treatment
Although the condition of leukonychia is completely harmless, it can be treated in the following ways:
- Antifungal medications
- Avoiding the use of allergy-causing chemicals
- Cosmetic treatments
Topical antifungal antibiotics beings used for the treatment of leukonychia
Conclusion
White spots on toenails, as well as fingernails, bother some people as they make your nails less appealing and ugly. There are several reasons why these spots appear and what do they indicate. The cause may be as simple as an allergy to your nail polish or the presence of a disease that is, as a symptom, causing your nails to deteriorate. Whatever the case may be, it is easy to diagnose and uncomplicated to treat these nail spots.
PhD Scholar (Pharmaceutics), MPhil (Pharmaceutics), Pharm D, B. Sc.
Uzma Zafar is a dedicated and highly motivated pharmaceutical professional currently pursuing her PhD in Pharmaceutics at the Punjab University College of Pharmacy, University of the Punjab. With a comprehensive academic and research background, Uzma has consistently excelled in her studies, securing first division throughout her educational journey.
Uzma’s passion for the pharmaceutical field is evident from her active engagement during her Doctor of Pharmacy (Pharm.D) program, where she not only mastered industrial techniques and clinical case studies but also delved into marketing strategies and management skills.
