Q&A

A 30-year-old client has suddenly developed white spots that are spreading on the nail plate. Could it be stress or a fungus?

Q.

My client is in her 30s and has been getting basic manicures since February. She suddenly developed white spots and the following week, the spots appeared to have spread on the nail plate (and they were larger). She said she was under stress. Is this a fungus? Her doctor told her not to get any more manicures.

A.

My client is in her 30s and has been getting basic manicures since February. She suddenly developed white spots and the following week, the spots appeared to have spread on the nail plate (and they were larger). She said she was under stress. Is this a fungus? Her doctor told her not to get any more manicures.

White spots on the nail occurring a short time after a manicure are usually caused by trauma due to over-vigorous manipulation in the area of the cuticles with metal or wooden instruments, or vigorous cutting of the cuticles. What happens is the nail matrix is injured and when the nail matrix is injured it shows up a few weeks later on the surface of the nail as a white spot. Therefore it is not necessary for the client to give up manicuring, but significant caution must be exercised in avoiding injury to the nail matrix (growth center) in the region of the cuticle. The nail matrix is right next to the cuticle and the trauma of over-vigorous manipulation can cause the white spots. It is true that a fungus can cause white spots on the nails, but white spots on the surface of the nails due to fungus usually occur on the toenails and are very unusual on the fingernails. However, if there is a possibility that this is fungus, which in this situation I would say is unlikely, then a dermatologist familiar with nail disorders should evaluate the patient and test for fungus. If there is no fungus there, then that confirms that trauma is the problem. If trauma is avoided, the white spots will grow out and disappear.

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