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What does it mean when the nails are white?
Leuconychia is a discoloration of the nail plate, that is, the uppermost area of the nail.
Leukonychia can be divided into:
- True white nails, characterized by a change in the nail plate (surface of the nail), the white spots migrate with the growth of the nail;
- Apparent white nails, caused by changes in tissues. The whitening is due to problems in the nail bed, it does not change due to nail growth.
White nails can:
- be congenital (exist from birth),
- be acquired.
The nail plate loses its transparency and appears white due to parakeratotic cells inside the nail belly.
The parakeratotic cells have a large nucleus containing keratohyaline.
According to a study by Yalçın Tüzün and Özge Karakuş in the Department of Dermatology, İstanbul University, the cells containing keratohyaline reflect light, which is why the nail in question appears white.
Whitening of the nail may occur:
- on the entire nail,
- as central spots or at the edges of the nail,
- as a horizontal or vertical line.
Types of white nails
The true white nail is a discoloration of the nail, which arises due to changes in the base of the nail and is divided into:
- complete
- partial.
Usually, a complete white nail is caused by an autosomal dominant genetic disease (rarely it is an autosomal recessive mode of inheritance), such as:
- Bart-Pumphrey syndrome, which can also lead to nail loss,
- Buschkell-Gorlin syndrome, which is also characterized by sebaceous cysts and kidney stones.
A partial white nail is characterized by a change in the proximal nail areas, i.e. the areas at the base of the nail, while the areas near the fingertip are pink.
This is the result of a delay in maturation of keratin.
Partial white nails are usually caused by trauma suffered:
- in manicures,
- in other types of trauma, for example when nails are bitten off.
The partial whitenail can be a phase of the complete whitenail.
A person may experience complete and partial whitening of the nails at different times.
There are three variants of partial whitening of the nail, which are distinguished according to their shape:
- punctiform
- striated, characterized by parallel and striated lines on the nail, appearing opaque and white,
- longitudinally striped.
Causes of white nails
White spots on the nails
White spots or inconsistent and isolated strokes in the middle of the nail are very common on the fingernails of:
- Adults
- Children.
They are stains in the nail plate.
If they are small, they do not indicate a disease, but they are simple air bubbles and one should therefore not worry.
The most common causes of these white spots can be:
- nail trauma, such as aggressive manicure or chewing on the nails;
- Nutritional deficiencies, for example: calcium, zinc and vitamin B6.
These spots disappear on their own over time.
Punctate whitening of the nails
This is the most common type and it affects healthy people.
The nail plate shows small white transparent spots that migrate to the tip of the nail with nail growth.
According to the scientists, the causes can be:
- abnormal keratinization,
- air entering between the cells,
- trauma,
- They can occur in patients suffering from alopecia areata (a local form of hair loss).
The spots may change during nail growth.
White longitudinal lines on the nails
Elongated or vertical lines are grooves or lines in relief of the nail surface.
It is a normal aging process.
Longitudinal lines on the nails often arise on the nails of women due to:
- trauma during manicure,
- inappropriate footwear (for toenails).
If white and streaky nails also show up in young people, this may indicate some conditions such as:
- eczema,
- lichen planus,
- Darier’s disease, this disease can also cause red lines,
- rheumatoid arthritis.
White transverse lines on the nails
Stripes on nails are safe only if they are painted.
White transverse lines can result from changes:
- the nail plate (Mees lines), i.e. on the surface,
- of the nail bed (Muehrcke lines), i.e. in the deeper area.
Mees Lines
Mees lines are horizontal stripes on the nail plate that occupy the entire width of the nail and which can be:
- single: one per finger,
- several: several parallels all over the nail.
According to a study by Archana Singal and Rahul Arora, published in the Indian Dermatol Online Journal, some infectious diseases can cause mees lines, most notably:
- pneumonia,
- tuberculosis,
- Malaria
- herpes zoster,
- Leprosy
The causes also include:
- arsenic or heavy metal poisoning,
- carbon monoxide poisoning,
- renal insufficiency,
- Chemoterapy.
The stripes can be present on all fingernails and toenails.
The lines shift with the growth of the nail and doctors can determine the time that has passed since the event that caused it.
Muehrcke Lines
White horizontal stripes are called Muehrcke lines if they:
- cross the entire nail,
- are present more than once,
- appear on different fingers,
- do not shift with nail growth.
Muehrcke lines are the result of fluid accumulation (edema) in the nail bed.
The causes can be:
- kidney disease,
- liver disease, such as cirrhosis,
- Lack of proteins, vitamins of group B, iron and zinc.
In general, shorter white signs or stripes are the result of trauma at the base of the nail.
These can last weeks to months and usually disappear on their own.
White nail from base to center
Lindsay nails or half and half
It is a nail change caused by chronic renal insufficiency.
As the term “half and half” suggests, these are characterized by:
- white color in the lower area,
- normal color in the end area.
Terry nails
The cause may be a fungal infection or reduced blood flow to the nail bed, also known as “Terry nails.”
Terry nails are completely white with slightly reddish or dark tips and can result from various diseases, including:
- Cirrhosis of the liver (liver fibrosis) – about 80% of cirrhosis patients have Terry nails
- Liver, kidney or heart failure
- Diabetes
- Iron deficiency anemia, in which a reduced number of red blood cells is present due to the lack of iron in the body
- Chemotherapy
- Hyperthyroidism (the thyroid gland in the throat produces too many hormones)
- Malnutrition.
Rough and irregular white nails
If the nails become thin and rough (like sandpaper), it is a disease called sandpaper nails.
Normally, all nails are affected, that’s why the disease is also called dystrophy of the 20 nails.
In this case, it is necessary to consider concomitant diseases, such as:
- regional hair loss,
- psoriasis,
- atopic dermatitis and
- lichen planus.
Nail detachment
After a finger injury, it is normal for the nail to be shed and fall off.
As a rule, this is the result of trauma and affects the end part of the nail.
The nail no longer looks pink, because it detaches from the skin and forms a cavity.
This process is called onycholysis: the nail detaches from the free edge (outer edge) from the nail bed.
After some time, it is completely repelled and falls off.
However, if no blow has been preceded, a nail can come loose as a result of:
- excessive nail treatment and nail cleansing (aggressive manicure),
- repeated contact with water and detergents,
- Application of aggressive cosmetic solvents.
A sticking nail can be the sign of the following diseases or substances:
Skin diseases
- fungal nail infection,
- Psoriasis of the nails – psoriasis is a chronic condition that can lead to the formation of red spots and dander,
- warts grouped around the nail,
- Contact dermatitis.
Systemic diseases
- Overactive thyroid gland (hyperthyroidism))
- Sarcoidosis, a disease in which small groups of granulomas (inflamed nodules) form in organs and body tissues. The nails of a person suffering from sarcoidosis may be deformed and damaged;
- amyloidosis, a disease manifested by an accumulation of abnormal proteins in the organs;
- Systemic lupus erythematosus, an autoimmune disease that affects the body’s connective tissue fibers that support organs and tissues;
- Poor circulation, caused, for example, by tobacco smoke or Raynaud’s disease (in which the skin of the fingers turns white in the cold).
Medication
- Allergic reaction to a drug (usually to a specific antibiotic) or to cosmetics for the nails.
Treatment of a peeling nail
- A detached nail should be cut directly at the detaching point so that the nail can grow again as it grows.
- It is recommended to disinfect the uncovered nail bed with hydrogen peroxide and apply an antiseptic ointment to prevent infection.
- You should only clean the nails with a soft brush.
