Don’t be alarmed if you notice your client’s nails turning white. It’s most likely a case of leukonychia and while it sounds serious, in reality, the discoloration may simply be a result of a minor injury to the nail.
n. (loo’ k -nˇk’e- ) A white spotting, streaking, or discoloration of the fingernails caused by injury or ill health.
What They Are
White spots on the nails may appear a bit frightening, but for the most part, leukonychia (which literally means “whiteness of the nails”) is harmless and may be caused simply from a minor injury that occurs when the nail is growing.
White nails are one of the most common chromatic nail abnormalities and can be divided into three main types: true leukonychia (total, subtotal, and partial leukonychia, and Mee’s line); apparent leukonychia (half-and-half nails, Terry’s nail, Muerchke’s line, Neapolitan nails, and onycholysis); and pseudo leukonychia (onychomycosis). Most of these types are acquired, and are associated with a systemic disease, chemical exposure, trauma, or infection.
The most common symptom associated with leukonychia is white nails. However, different pigmentation is seen in some leukonychias, including half-and-half nails, which are white on the proximal nail bed and red, pink, or brown on the distal nail bed. Transverse leukonychia shows white lines, leukonychia punctata is characterized by white spots, and Terry’s nails are mainly all white.
Skin cysts and abnormal-colored nails can also be symptoms of leukonychia.
There are many types of nail whiteness, some of which indicate serious illness. Fortunately, the most common cause of white spots on the nail is minor injury to the nail matrix.
The natural nail plate is made up of the keratinization of cells incubated and produced by the matrix. When new cells emerge from the matrix, they appear as round, white splotches.
During the keratinization process, these cells flatten out and link together to form the natural nail plate. When large areas of these white splotches do not keratinize, they end up with white splotches on them. These spots are most often caused by some type of trauma or damage to the matrix during the incubation or keratinization period.
Leukonychia spots are usually seen within the natural nail plate instead of on top of it. If they appear on the top portion of the natural nail plate they usually flake off, leaving behind small pits where the cells should have keratinized with other cells.
In pseudo leukonychia, the nails temporarily become white when an area of the natural nail becomes stripped of oil and moisture. This is often due to excessive use of solvent on the nails. Any type of solvent will strip oil and moisture from the skin and the uppermost layers of the natural nail plate.
Clients who have thinner natural nails may have more of a problem with pseudo leukonychia.
Leukonychia may also appear as a rare side effect of systemic chemotherapy in some oncological patients. It may also appear with arsenic poisoning, renal failure, pneumonia, or heart disease.
How to Treat Them
There is no effective treatment for leukonychia. However, reducing minor injury to the nails prevents the white marks and spots that will gradually disappear as the nail grows outward from the matrix with the nail plate.
Since some forms of leukonychia are associated with serious illness, it is important to seek advice from a doctor to determine if there is an underlying cause that needs to be treated.
Considerations for Nail Techs
Keep in mind that leukonychia can be caused by pushing the cuticles back too vigorously with a metal or wooden instrument. Be sure to soften the cuticles first with lotion or warm water before pushing them back, and use gentle pressure. If your client’s condition persists, recommend she see a doctor.