Description::
Leukonychia (or leuconychia), also known as white nails or milk spots, is a medical term for white discoloration appearing on nails. It is derived from the Greek words leuko (“white”) and onux (“nail”). The most common cause is injury to the base of the nail (the matrix) where the nail is formed…..CLICK & SEE
It is harmless and most commonly caused by minor injuries that occur while the nail is growing. Contrary to popular belief, leukonychia is not a sign of excess or deficiency of calcium and zinc or other vitamins in the diet but rather less commonly a medical sign of hypoalbuminemia or chronic liver disease. It is more commonly found on fingernails than toenails. There is no effective treatment for leukonychia. However, the white marks and spots gradually disappear as the nail grows outward from the matrix with the nail plate.
Leukonychia is a nail condition. It manifests as the nail changing color either partially or fully. This disease can be caused by systemic problems or most commonly, it is a genetic disorder. The nail appears to have the standard shape and appearance, except for the fact that the nail turns white. This is caused by the presence of “parakeatotic cells”. These cells have an undeveloped and bulky nucleus, which contain ‘keratohyalins’. This cell variation causes the nail to reflect light and makes the nail appear opaque white.
Types:
Leukonychia totalis :
This condition is a whitening of the entire nail. This may be a clinical sign of hypoalbuminaemia (low albumin), which can be seen in nephrotic syndrome (a form of kidney failure), liver failure, protein malabsorption and protein-losing enteropathies. A genetic condition, and a side effect of sulphonamides, a family of antibiotics can also cause this appearances.
Leukonychia partialis:
This condition is whitening of parts of the nail plate in form of small white dots. There are several types of this condition. There are three variations of partial leukonychia; punctate, transverse and longitudinal leukonychia. Some more serious variations of leukonychia partialis may lead to Leukonychia totalis.
Leukonychia striata:
Leukonychia striata, transverse leukonychia, or Mees’ lines are a whitening or discoloration of the nail in bands or “stria” that run parallel the lunula (nail base). This is commonly caused by physical injury or disruption of the nail matrix. Common examples include excessive tapping of the nails, slamming a car door or extensive use of manicure. It may also occur in great toenails as a result of trauma from footwear. Alternatively, the condition can be caused by heavy metal poisoning most commonly by lead or arsenic. It can also be caused by cirrhosis or chemotherapy. The tendency toward leukonychia striata is sometimes inherited in an autosomal dominant fashion. In other cases, it can be attributed to vigorous manicuring and trauma aforementioned, or to a wide variety of systemic illnesses. Serious infections known for high fevers, measles, malaria, herpes, and leprosy may also cause this condition. In many patients, there is no obvious cause, and the streaks resolve spontaneously. There is a similar condition called Muehrcke’s lines (apparent leukonychia) which differs from leukonychia in that the lines fade with digital compression and does not migrate with the growth of the nail.
Leukonychia punctata:
Also known as “true” leukonychia, this is the most common form of leukonychia, in which small white spots appear on the nails. Picking and biting of the nails are a prominent cause in young children and nail biters. Besides parakeratosis, air that is trapped between the cells may also cause this appearance. It is also caused by trauma. In most cases, when white spots appear on a single or a couple of fingers or toes, the most common cause is injury to the base (matrix) of the nail. When this is the case, white spots disappear after around eight weeks, which is the amount of time necessary for nails to regrow completely. The pattern and number of spots may change as the nail grows.
Longitudinal leukonychia:
Longitudinal leukonychia is far less common and features smaller 1mm white longitudinal lines visible under the nail plate. It may be associated with Darier’s disease.
Symptoms :
Some of the obvious signs of leukonychia are white spots on the fingernail. It is observed in the form of small white lines on the nails and change in color of the nails which become totally white. The white spots may also occur on toenails. The nails become colorless and brittle losing the original texture. The nail may change its color to fully white (leukonychia totalis) or half white (leukonychia partialis).
Apart from the above signs, the person affected with leukonychia may also have problems like deafness, gingivitis, and hyperkeratosis and hammer toes if they are suffering from systemic disorders.
Causes:
It can be due to nail injury or infection. Sometimes it can be due to nail disorder or bacterial infection on the nail-bed. The white spots and change of nail to full-white color is due to the presence of para-karyotic cells that contains a compound called keratohyalins. On reflection to the light the normal color of the nail looks fully white.
Leukonychia can also occur due to heavy poisoning, heart problem, kidney disease, malnutrition, vitamin deficiency and stress.
Lack of essential nutrients like zinc and protein can also cause discoloration of nails. Ulcer in advance form can affect the fingernails. Further it can be caused due to pneumonia and hepatic cirrhosis and various other skin problems.People with diseases like typhoid, cholera, rheumatic fever, and colitis may also show this symptom of white spots on fingernails.
Individuals with family history of leukonychia have more chance of developing this problem than others. Patients who are undergoing chemotherapy or radiation treatment for cancer may also get this disease. Prolonged use of nail enamels and nail hardeners can be the reason for white spots on the fingernail. Bacterial or fungal infection on the nails can cause this problem.
True Leukonychia:
This type of Leukonychia is broken into two variations, total leukonychia and partial leukonychia. The difference seems to lie in the nail being either fully white, or only two thirds discolored as it takes a while for the maturation of the keratin to occur and change.
Total Leukonychia is an autosomal dominant condition. Other circumstances that may cause total leukonychia to occur are;
*Leprosy
*Typhoid
*Cytotoxic drugs
*Nail Biting
*Partial Leukonychia is viewed as a phase of total leukonychia. The most common causes of partial leukonychia are:
*Metastatic carcinoma
*Tuberculosis
*Leprosy
There are three different variants of partial leukonychia.
1.Transverse leukonychia – This causes the nail plate to be multi colored in its opacity. It is seen mostly in women’s fingernails. Possible causes are:
*Acute respiratory infections
*High fever
*Malaria
*Leprosy
2.Punctuate leukonychia – This is the most common form and can happen to anyone. The telltale symptom is that the nail appears to have tiny opaque spots which fade with time.
3.Longitudinal leukonychia – A small white line under the nail plate
Pseudo Leukonychia
*This occurs when a discoloration in the nail appears due to a change in the nail bed. Pseudo leukonychia has three different forms:
*Terry’s nails – This affects the majority of the nail and makes it multi-colored. The majority of the nail is white, the rest, pink or brown.
Muhrecke’s nails – The nail appears to have several white transverse bands
*Half and half nails – This is seen as a larger part of the nail being dull white and the rest being brownish in color.
Diagnoses :
It is easy to identify this disease by physically examining the nails of the person affected. If needed, your doctor will ask you to do blood culture and other test for measuring the nutrients like zinc and vitamins. The doctor will take a thorough medical history, and may take blood tests as well as examining liver and kidney function.
Treatment :
You can get some relief from the symptoms by including lot of nutrition in your daily diet. Proteins, vitamins and zinc are essential elements that are to be added in daily food. You can eat nuts and green leafy veggies that carry lot of zinc.
The white spots on the fingernail will gradually diminish if you start taking zinc in daily food.In case if the problem is due to anemia then you will be given folic acid and iron supplement pills. If the symptoms are due to renal failure, then your doctor will initiate treatment for the condition. Suitable medicines will be given for treating the underlying disease like liver problem or ulcer or anemia.
Do not change your nail polish frequently and always use trusted brands. Limit the usage of nail enamels and polish to certain occasions. Avoid biting your nails since it may worsen the condition.
In case if the white spots or white coloration on the fingernails does not improve for more than 2 months, you can consult your doctor who would help you to find the actual cause.
Almost in many cases, the symptoms of leukonychia are due to deficiency of nutrients and zinc and only in rare cases, it will be due to underlying systemic disorders.
Increasing the quantity of grains, vegetables and nuts and even taking a zinc supplement (as zinc deficiency is a cause of leukonychia) is a good preventative and treatment, as is keeping affected nails out of harms way when using chemicals of any kind as they can further damage the nail.
Resources:
http://en.wikipedia.org/wiki/Leukonychia
http://diseasespictures.com/leukonychia/
