Leukonychia: Difference between revisions

Leukonychia
Leukonychia
Other names	White nails or Milk spots
Specialty	Dermatology

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Leukonychia (or leuconychia) is a medical term for white discoloration appearing on nails.^[2] It is derived from the Greek words leuko 'white' and onyx 'nail'. The most common cause is injury to the base of the nail (the matrix) where the nail is formed.

Types

Leukonychia totalis

This condition consists of a whitening of the entire nail and mostly likely occurs on all nails. Whitening of one, and only one, entire nail is not recognized as a symptom of leukonychia totalis but as a likely result of mechanical trauma. Leukonychia totalis 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 or a side effect from taking sulphonamides (a family of antibiotics) can also cause this appearance. By 2011, only 6 cases of non-hereditary leukonychia totalis were published.^[3]

In familial cases of leukonychia totalis, this condition is caused by mutations in the PLCD1 gene, in chromosome 3p22.2, this mutation shows an autosomal dominant pattern of inheritance, but in some cases, this condition may be autosomal recessive.^[4]

Leukonychia partialis

This condition consists of a whitening of parts of the nail plate in the form of small white dots. There are three different variations of partial leukonychia; punctate, transverse and longitudinal leukonychia. Some of the more serious variations of leukonychia partialis may lead to leukonychia totalis.^[5]

Leukonychia striata

Leukonychia striata, transverse leukonychia, or Mees' lines are a whitening or discoloration of the nail in bands or "stria" that run parallel to the lunula (nail base). This is commonly caused by physical injury or disruption of the nail matrix. Common examples include excessive biting or tapping of the nails, trauma or injury from accidents involving doors or windows, and extensive use of manicure.^[6] 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.^[7] Finally, it can be caused by cirrhosis of the liver or chemotherapy.^[8]

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.^[9]

There is a similar condition called Muehrcke's lines (apparent leukonychia) which differs from leukonychia in that the lines fade with digital compression and do not migrate with the growth of the nail.^[10]

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.^[5] It is also caused by trauma. In most cases, when white spots appear on a single or a couple of fingernails or toenails, the most common cause is injury to the base (matrix) of the nail. When this is the case, white spots disappear after around eight months, which is the amount of time the nails take to regrow completely. The pattern and number of spots may change as the nail grows.^[11]

Longitudinal leukonychia

Longitudinal leukonychia is far less common and features smaller 1mm white longitudinal lines visible under the nail plate and perpendicular to the nail bed. It may be associated with Darier's disease.^[5]

Apparent leukonychia

Apparent leukonychia is caused by changes in the nail bed that are visible through the nail plate. A number of patterns of apparent leukoncychia, including Terry's nails, half-and-half (Lindsay's) nails, and Muehrcke's lines, have been classically characterized.^[12]

Cause

It is harmless and most commonly caused by minor injuries, such as nail biting, or may occur while the nail is growing. Some people suggest that it also may be caused by calcium deficiency,^[13] although this is not backed up by research. Leukonychia occurs most commonly in healthy individuals, and is unrelated to any known nutritional or physiological deficiency.^[5] When caused by injury the marks will disappear as the nail grows outwards. While there are various sources that link dietary needs or vitamin deficiency with recurrent leukonychia,^[14] this notion has been challenged by some medical researchers.^[15]

Other possible reasons for this problem can be linked to:

Diagnosis

A doctor will take a thorough medical history, and may take blood tests as well as examining liver and kidney function. Intracellular (red blood cell) assays are more sensitive than tests for plasma levels.^[18]

Treatment

Improvements have been reported from treating malnutrition associated with zinc deficiency and other minerals.^[19]^[20]

References

^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. p. 789. ISBN 0-7216-2921-0.
^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. pp. 658–59. ISBN 0-07-138076-0.
^ Arsiwala, Shehnaz (2012). "Idiopathic acquired persistent true partial to total leukonychia". Indian Journal of Dermatology, Venereology and Leprology. 78 (1): 107–8. doi:10.4103/0378-6323.90962. PMID 22199074.
^ "Leukonychia totalis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".
^ ^a ^b ^c ^d Tüzün, Yalçın; Karakuş, Özge (2009). "Leukonychia" (PDF). Journal of Turkish Academy of Leukonychia: 1–3. Archived from the original (PDF) on March 3, 2016. Retrieved April 2, 2017.
^ Iorizzo, Matilde; Starace, Michela; Pasch, Marcel C. (March 2022). "Leukonychia: What Can White Nails Tell Us?". American Journal of Clinical Dermatology. 23 (2): 177–193. doi:10.1007/s40257-022-00671-6. ISSN 1179-1888. PMC 8809498. PMID 35112320.
^ Baran R, de Berker DA, Holzberg M, Thomas L (2012). Baran and Dawber's Diseases of the Nails and their Management. John Wiley & Sons. p. 417. ISBN 9781118286708.
^ Miles DW, Rubens RD (1995). "Images in clinical medicine. Transverse leukonychia". N. Engl. J. Med. 333 (2): 100. doi:10.1056/NEJM199507133330205. PMID 7777013.
^ "Pictures of Nail Diseases and Problems - Leukonychia Striata".
^ Huang, T.-C.; Chao, T.-Y. (14 December 2009). "Mees lines and Beau lines after chemotherapy". Canadian Medical Association Journal. 182 (3): E149. doi:10.1503/cmaj.090501. PMC 2826482. PMID 20008502.
^ "My Big Fat Greek Leukonychia".
^ Lawry, Monica; Daniel, C Ralph (2005). "Nails in Systemic Disease". Nails. Elsevier. pp. 147–176. doi:10.1016/b978-141602356-2.50021-9. ISBN 978-1-4160-2356-2.
^ Schocker, Laura (24 September 2013). "15 Things You Never Knew About Your Nails". HuffPost UK.
^ "White Spots On Nails: Should You Be Worried?". CureJoy. 6 March 2018. They may also be caused by zinc or albumin deficiency, which is curable.
^ Morgan, Z.; Wickett, H. (6 May 2011). "Leukonychia on finger nails as a marker of calcium and/or zinc deficiency". Journal of Human Nutrition and Dietetics. 24 (3): 294–295. doi:10.1111/j.1365-277X.2011.01175_23.x. The results showed there was no correlation between calcium or zinc intake scores and leukonychia.
^ Rendon, Adriana; Schäkel, Knut (23 March 2019). "Psoriasis Pathogenesis and Treatment". International Journal of Molecular Sciences. 20 (6): 1475. doi:10.3390/ijms20061475. PMC 6471628. PMID 30909615.
^ "Leukonychia – Symptoms, Causes, Treatment, Pictures". byebyedoctor.com. 18 May 2011. Retrieved 2017-05-18.
^ Kelly MP, Kight MA, Castillo S (July 1998). "Trophic implications of altered body composition observed in or near the nails of hemodialysis patients". Advances in Renal Replacement Therapy. 5 (3): 241–51. doi:10.1016/S1073-4449(98)70037-8. PMID 9686635.
^ Meyer, Bhika (November 2014). "Nails as Indicators of Disease" (PDF). Science of Medicine and Art of Care – via Tibb Institute.
^ Wollina U, Nenoff P, Haroske G, Haenssle HA (July 2016). "The Diagnosis and Treatment of Nail Disorders". Deutsches Ärzteblatt International. 113 (29–30): 509–18. doi:10.3238/arztebl.2016.0509. PMC 5527843. PMID 27545710.

External links

[Andrews-1] James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. p. 789. ISBN 0-7216-2921-0.

[Fitz2-2] Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. pp. 658–59. ISBN 0-07-138076-0.

[3] Arsiwala, Shehnaz (2012). "Idiopathic acquired persistent true partial to total leukonychia". Indian Journal of Dermatology, Venereology and Leprology. 78 (1): 107–8. doi:10.4103/0378-6323.90962. PMID 22199074.

[4] "Leukonychia totalis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".

[Tüzün_&_Karakuş-5] Tüzün, Yalçın; Karakuş, Özge (2009). "Leukonychia" (PDF). Journal of Turkish Academy of Leukonychia: 1–3. Archived from the original (PDF) on March 3, 2016. Retrieved April 2, 2017.

[6] Iorizzo, Matilde; Starace, Michela; Pasch, Marcel C. (March 2022). "Leukonychia: What Can White Nails Tell Us?". American Journal of Clinical Dermatology. 23 (2): 177–193. doi:10.1007/s40257-022-00671-6. ISSN 1179-1888. PMC 8809498. PMID 35112320.

[7] Baran R, de Berker DA, Holzberg M, Thomas L (2012). Baran and Dawber's Diseases of the Nails and their Management. John Wiley & Sons. p. 417. ISBN 9781118286708.

[8] Miles DW, Rubens RD (1995). "Images in clinical medicine. Transverse leukonychia". N. Engl. J. Med. 333 (2): 100. doi:10.1056/NEJM199507133330205. PMID 7777013.

[9] "Pictures of Nail Diseases and Problems - Leukonychia Striata".

[10] Huang, T.-C.; Chao, T.-Y. (14 December 2009). "Mees lines and Beau lines after chemotherapy". Canadian Medical Association Journal. 182 (3): E149. doi:10.1503/cmaj.090501. PMC 2826482. PMID 20008502.

[11] "My Big Fat Greek Leukonychia".

[Lawry_Daniel_2005_pp._147–176-12] Lawry, Monica; Daniel, C Ralph (2005). "Nails in Systemic Disease". Nails. Elsevier. pp. 147–176. doi:10.1016/b978-141602356-2.50021-9. ISBN 978-1-4160-2356-2.

[13] Schocker, Laura (24 September 2013). "15 Things You Never Knew About Your Nails". HuffPost UK.

[14] "White Spots On Nails: Should You Be Worried?". CureJoy. 6 March 2018. They may also be caused by zinc or albumin deficiency, which is curable.

[15] Morgan, Z.; Wickett, H. (6 May 2011). "Leukonychia on finger nails as a marker of calcium and/or zinc deficiency". Journal of Human Nutrition and Dietetics. 24 (3): 294–295. doi:10.1111/j.1365-277X.2011.01175_23.x. The results showed there was no correlation between calcium or zinc intake scores and leukonychia.

[16] Rendon, Adriana; Schäkel, Knut (23 March 2019). "Psoriasis Pathogenesis and Treatment". International Journal of Molecular Sciences. 20 (6): 1475. doi:10.3390/ijms20061475. PMC 6471628. PMID 30909615.

[17] "Leukonychia – Symptoms, Causes, Treatment, Pictures". byebyedoctor.com. 18 May 2011. Retrieved 2017-05-18.

[pmid9686635-18] Kelly MP, Kight MA, Castillo S (July 1998). "Trophic implications of altered body composition observed in or near the nails of hemodialysis patients". Advances in Renal Replacement Therapy. 5 (3): 241–51. doi:10.1016/S1073-4449(98)70037-8. PMID 9686635.

[19] Meyer, Bhika (November 2014). "Nails as Indicators of Disease" (PDF). Science of Medicine and Art of Care – via Tibb Institute.

[pmid27545710-20] Wollina U, Nenoff P, Haroske G, Haenssle HA (July 2016). "The Diagnosis and Treatment of Nail Disorders". Deutsches Ärzteblatt International. 113 (29–30): 509–18. doi:10.3238/arztebl.2016.0509. PMC 5527843. PMID 27545710.

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@@ Line 1: / Line 1: @@
+{{short description|White spots on finger and toe nails}}
-{{medref|date=October 2014}}
-{{Infobox medical condition
+{{more medical citations needed|date=October 2014}}
+{{Infobox medical condition (new)
- | Name           = Leukonychia
- | Image          = Leukonychia.jpg
+| name            = Leukonychia
+| synonyms        =  '''White nails''' or '''Milk spots'''<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. p. 789. {{ISBN|0-7216-2921-0}}.</ref>
- | Caption        = Leukonychia
- | Field          = [[Dermatology]]
+| image           = Leukonychia.jpg
- | DiseasesDB     = 14140
+| caption         =
+| pronounce       =
- | ICD10          = {{ICD10|L|60|8|l|60}}, {{ICD10|Q|84|4|q|80}}
+| field    = [[Dermatology]]
- | ICD9           = {{ICD9|703.8}}, {{ICD9|757.5}}
- | ICDO           =
+| symptoms        =
- | OMIM           =
+| complications   =
- | MedlinePlus    =
+| onset           =
- | eMedicineSubj  =
+| duration        =
+| types           =
- | eMedicineTopic =
- | MeshID         =
+| causes          =
+| risks           =
+| diagnosis       =
+| differential    =
+| prevention      =
+| treatment       =
+| medication      =
+| prognosis       =
+| frequency       =
+| deaths          =
 }}
-'''Leukonychia''' (or '''leuconychia'''), also known as '''white nails''' or '''milk spots''',<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. Page 789. ISBN 0-7216-2921-0.</ref> is a medical term for white discoloration appearing on [[nail (anatomy)|nails]].<ref name="Fitz2">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.</ref>{{rp|658–9}}  It is derived from the Greek words ''leuko'' ("white") and ''nychia'' ("nails"). The most common cause is injury to the base of the nail (the matrix) where the nail is formed.
+'''Leukonychia''' (or '''leuconychia''') is a medical term for white discoloration appearing on [[nail (anatomy)|nails]].<ref name="Fitz2">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. pp. 658–59. {{ISBN|0-07-138076-0}}.</ref> It is derived from the Greek words ''leuko'' 'white' and ''onyx'' 'nail'. The most common cause is injury to the base of the nail (the matrix) where the nail is formed.
+==Types==
-It is harmless and most commonly caused by minor injuries, such as [[nail biting]], that occur while the nail is growing.<ref>{{cite web|url=http://www.huffingtonpost.com/2013/09/24/nail-facts-fingernails_n_3957467.html|title=15 Things You Never Knew About Your Nails|first1=Laura Schocker Executive|last1=Editor|first2=|last2=Realsimple.com|date=24 September 2013|publisher=}}</ref>  Leukonychia occurs most commonly in healthy individuals, unrelated to any known nutritional or physiological deficiency.<ref>http://www.jtad.org/2009/1/jtad93101r.pdf</ref> When caused by injury the marks will disappear as the nail grows outwards, however a dietary deficiency will cause recurrent leukonychia.
+===Leukonychia totalis===
+[[File:Idiopathic Leukonychia totalis.jpg|thumb|right|Leukonychia totalis]]
+This condition consists of a whitening of the entire nail and mostly likely occurs on all nails. Whitening of one, and only one, entire nail is not recognized as a symptom of leukonychia totalis but as a likely result of mechanical trauma. Leukonychia totalis 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 [[Enteropathy|enteropathies]]. A [[Genetics|genetic]] condition or a side effect from taking [[sulfonamide (medicine)|sulphonamides]] (a family of [[antibiotics]]) can also cause this appearance. By 2011, only 6 cases of non-hereditary leukonychia totalis were published.<ref>{{cite journal |last1=Arsiwala |first1=Shehnaz |title=Idiopathic acquired persistent true partial to total leukonychia |journal=Indian Journal of Dermatology, Venereology and Leprology |date=2012 |volume=78 |issue=1 |pages=107–8 |doi=10.4103/0378-6323.90962|pmid=22199074 |doi-access=free }}</ref>
+In familial cases of leukonychia totalis, this condition is caused by mutations in the [[PLCD1]] gene, in chromosome [[Chromosome 3|3p22.2]], this mutation shows an autosomal [[Dominance (genetics)|dominant]] pattern of inheritance, but in some cases, this condition may be autosomal recessive.<ref>{{Cite web|url=https://rarediseases.info.nih.gov/diseases/9759/leukonychia-totalis|title = Leukonychia totalis &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program}}</ref>
+===Leukonychia partialis===
+[[File:Leukonychia2.jpg|thumb|Leukonychia partialis]]
+This condition consists of a whitening of parts of the nail plate in the form of small white dots. There are three different variations of partial leukonychia; punctate, transverse and longitudinal leukonychia. Some of the more serious variations of leukonychia partialis may lead to leukonychia totalis.<ref name="Tüzün & Karakuş"/>
+====Leukonychia striata====
+[[File:Mees' lines.jpg|thumb|Leukonychia striata]]
+{{main|Mees' lines}}
+Leukonychia striata, transverse leukonychia, or [[Mees' lines]] are a whitening or discoloration of the nail in bands or "stria" that run parallel to the [[Lunula (anatomy)|lunula]] (nail base). This is commonly caused by physical injury or disruption of the nail matrix. Common examples include excessive biting or tapping of the nails, trauma or injury from accidents involving doors or windows, and extensive use of manicure.<ref>{{Cite journal |last1=Iorizzo |first1=Matilde |last2=Starace |first2=Michela |last3=Pasch |first3=Marcel C. |date=March 2022 |title=Leukonychia: What Can White Nails Tell Us? |journal=American Journal of Clinical Dermatology |volume=23 |issue=2 |pages=177–193 |doi=10.1007/s40257-022-00671-6 |issn=1179-1888 |pmc=8809498 |pmid=35112320}}</ref> It may also occur in great toenails as a result of trauma from footwear. Alternatively, the condition can be caused by [[Heavy metals|heavy metal]] poisoning, most commonly by [[lead]].<ref>{{cite book |last1=Baran |first1=Robert |last2=de Berker |first2=David A. R. |last3=Holzberg |first3=Mark |last4=Thomas |first4=Luc | name-list-style = vanc |title=Baran and Dawber's Diseases of the Nails and their Management|date=2012|publisher=John Wiley & Sons|isbn=9781118286708|page=417|url=https://books.google.com/books?id=ekr4Bt683c8C&pg=PT417}}</ref> Finally, it can be caused by [[cirrhosis|cirrhosis of the liver]] or [[chemotherapy]].<ref>{{cite journal |vauthors=Miles DW, Rubens RD |title=Images in clinical medicine. Transverse leukonychia |journal=N. Engl. J. Med. |volume=333 |issue=2 |pages=100 |year=1995 |pmid=7777013 |doi=10.1056/NEJM199507133330205}}</ref>
+The tendency toward leukonychia striata is sometimes inherited in an [[autosomal dominant inheritance|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.<ref>{{cite web|url=http://www.emedicinehealth.com/script/main/art.asp?articlekey=110224|title=Pictures of Nail Diseases and Problems - Leukonychia Striata}}</ref>
+There is a similar condition called [[Muehrcke's lines]] (apparent leukonychia) which differs from leukonychia in that the lines fade with digital compression and do not migrate with the growth of the nail.<ref>{{cite journal|last=Huang|first=T.-C.|author2=Chao, T.-Y. |title=Mees lines and Beau lines after chemotherapy|journal=Canadian Medical Association Journal|date=14 December 2009|volume=182|issue=3|pages=E149|doi=10.1503/cmaj.090501|pmid=20008502|pmc=2826482}}<!--|access-date=14 July 2012--></ref>
+====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.<ref name="Tüzün & Karakuş"/> It is also caused by trauma. In most cases, when white spots appear on a single or a couple of fingernails or toenails, the most common cause is injury to the base (matrix) of the nail. When this is the case, white spots disappear after around eight months, which is the amount of time the nails take to regrow completely. The pattern and number of spots may change as the nail grows.<ref>{{cite web|url=http://www.salongeek.com/health-safety-unatural/6245-my-big-fat-greek-leukonychia.html|title=My Big Fat Greek Leukonychia}}</ref>
+====Longitudinal leukonychia====
+Longitudinal leukonychia is far less common and features smaller 1mm white longitudinal lines visible under the nail plate and perpendicular to the nail bed. It may be associated with [[Darier's disease]].<ref name="Tüzün & Karakuş"/>
+=== Apparent leukonychia ===
+Apparent leukonychia is caused by changes in the nail bed that are visible through the nail plate. A number of patterns of apparent leukoncychia, including [[Terry's nails]], [[Half and half nail|half-and-half (Lindsay's) nails]], and [[Muehrcke's nails|Muehrcke's lines]], have been classically characterized.<ref name="Lawry Daniel 2005 pp. 147–176">{{cite book | last1=Lawry | first1=Monica | last2=Daniel | first2=C Ralph | title=Nails | chapter=Nails in Systemic Disease | publisher=Elsevier | year=2005 | isbn=978-1-4160-2356-2 | doi=10.1016/b978-141602356-2.50021-9 | pages=147–176}}</ref>
+==Cause==
+[[File:White spot in nail.jpg|thumb|Particularly large white spot]]
+It is harmless and most commonly caused by minor injuries, such as [[nail biting]], or may occur while the nail is growing. Some people suggest that it also may be caused by calcium deficiency,<ref>{{cite web|url=http://www.huffingtonpost.com/2013/09/24/nail-facts-fingernails_n_3957467.html|title=15 Things You Never Knew About Your Nails|last1=Schocker|first1=Laura|website=HuffPost UK|date=24 September 2013}}</ref> although this is not backed up by research. Leukonychia occurs most commonly in healthy individuals, and is unrelated to any known nutritional or physiological deficiency.<ref name="Tüzün & Karakuş">{{cite journal|last1=Tüzün|first1=Yalçın|last2=Karakuş|first2=Özge|title=Leukonychia|journal=Journal of Turkish Academy of Leukonychia|date=2009|pages=1–3|url=http://www.jtad.org/2009/1/jtad93101r.pdf|access-date=April 2, 2017|archive-url=https://web.archive.org/web/20160303225703/http://www.jtad.org/2009/1/jtad93101r.pdf|archive-date=March 3, 2016|url-status=dead}}</ref> When caused by injury the marks will disappear as the nail grows outwards. While there are various sources that link dietary needs or vitamin deficiency with recurrent leukonychia,<ref>{{cite web|url=https://www.curejoy.com/content/what-causes-white-spots-on-nails/|title=White Spots On Nails: Should You Be Worried?|date=6 March 2018|website=CureJoy|quote=They may also be caused by zinc or albumin deficiency, which is curable.}}</ref> this notion has been challenged by some medical researchers.<ref>{{cite journal|last1=Morgan|first1=Z.|last2=Wickett|first2=H.|date=6 May 2011|title=Leukonychia on finger nails as a marker of calcium and/or zinc deficiency|journal=Journal of Human Nutrition and Dietetics|volume=24|issue=3|pages=294–295|quote=The results showed there was no correlation between calcium or zinc intake scores and leukonychia.|doi=10.1111/j.1365-277X.2011.01175_23.x}}</ref>
+Other possible reasons for this problem can be linked to:
-Other possible reasons for this problem with nail color can be linked to:
 * [[Arsenic poisoning]]
+* [[Lead poisoning]]
 * [[Pneumonia]]
 * [[Cardiovascular disease|Heart disease]]
-* [[Kidney failure|Renal failure]]
+* [[Kidney failure]]
 * Ill health
 * [[Hypoalbuminemia]]
 * [[Vitamin deficiency]]
 * [[Ulcerative colitis]]
-* [[Cirrhosis|Hepatic cirrhosis]]
+* [[Cirrhosis|Liver cirrhosis]]
 * Psychogenic stresses
 * [[Nail biting|Onychophagia]]
+* Trauma injury
 * Occupational trauma
 * [[Zinc deficiency]]
 * [[Protein (nutrient)|Protein deficiency]]
+* [[Psoriasis]]<ref>{{cite journal |last1=Rendon |first1=Adriana |last2=Schäkel |first2=Knut |title=Psoriasis Pathogenesis and Treatment |journal=International Journal of Molecular Sciences |date=23 March 2019 |volume=20 |issue=6 |pages=1475 |doi=10.3390/ijms20061475|pmid=30909615 |pmc=6471628 |doi-access=free }}</ref>
-* [[Psoriasis]] as well as eczema
-*[[Iron deficiency]]
+* [[Eczema]]
+*[[Iron deficiency]]<ref>{{Cite web|url=http://byebyedoctor.com/leukonychia/|title=Leukonychia – Symptoms, Causes, Treatment, Pictures|website=byebyedoctor.com|date=18 May 2011 |access-date=2017-05-18}}</ref>
-[http://byebyedoctor.com/leukonychia/]
-==Types==
+==Diagnosis ==
+A doctor will take a thorough [[medical history]], and may take blood tests as well as examining [[liver]] and [[kidney]] function. Intracellular (red blood cell) assays are more sensitive than tests for plasma levels.<ref name="pmid9686635">{{cite journal | vauthors = Kelly MP, Kight MA, Castillo S | title = Trophic implications of altered body composition observed in or near the nails of hemodialysis patients | journal = Advances in Renal Replacement Therapy | volume = 5 | issue = 3 | pages = 241–51 | date = July 1998 | pmid = 9686635 | doi = 10.1016/S1073-4449(98)70037-8 }}</ref>
-[[File:Leukonychia2.jpg|thumb|Leukonychia partialis]]
+==Treatment==
-===Leukonychia totalis===
+Improvements have been reported from treating malnutrition associated with [[zinc deficiency]] and other minerals.<ref>{{Cite journal|last=Meyer|first=Bhika|date=November 2014|title=Nails as Indicators of Disease|url=http://www.tibb.co.za/articles/Nails-as-indicators-of-health-status.pdf|journal=Science of Medicine and Art of Care|via=Tibb Institute}}</ref><ref name="pmid27545710">{{cite journal | vauthors = Wollina U, Nenoff P, Haroske G, Haenssle HA | title = The Diagnosis and Treatment of Nail Disorders | journal = Deutsches Ärzteblatt International | volume = 113 | issue = 29–30 | pages = 509–18 | date = July 2016 | pmid = 27545710 | pmc = 5527843 | doi = 10.3238/arztebl.2016.0509  }}</ref>
-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 [[Enteropathy|enteropathies]]. A [[Genetics|genetic]] condition, and a side effect of [[sulfonamide (medicine)|sulphonamides]] (a family of [[antibiotics]]) can also cause this appearance.
-===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.<ref name="jtad.org">[http://www.jtad.org/2009/1/jtad93101r.pdf Journal of Turkish Academy of Leukonychia]</ref>
-====Leukonychia striata====
-[[File:Mee's lines.JPG|thumb|Leukonychia striata]]
-{{main article|Mees' lines}}
-Leukonychia striata, transverse leukonychia, or [[Mees' lines]] are a whitening or discoloration of the nail in bands or "stria" that run parallel the [[Lunula (anatomy)|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.<ref>{{cite web|url=http://www.medscape.com/viewarticle/467074|title=Medscape Log In|publisher=}}</ref> It may also occur in great toenails as a result of trauma from footwear. Alternatively, the condition can be caused by [[Heavy metals|heavy metal]] poisoning most commonly by [[lead]].<ref>Baran, Robert et al. [https://books.google.com/books?id=ekr4Bt683c8C&pg=PT417 Baran and Dawber's Diseases of the Nails and Their Management]. John Wiley & Sons, 2012</ref> It can also be caused by [[cirrhosis]] or [[chemotherapy]].<ref>{{cite journal |vauthors=Miles DW, Rubens RD |title=Images in clinical medicine. Transverse leukonychia |journal=N. Engl. J. Med. |volume=333 |issue=2 |pages=100 |year=1995 |pmid=7777013 |doi=10.1056/NEJM199507133330205|url=http://content.nejm.org/cgi/content/short/333/2/100}}</ref>
-The tendency toward leukonychia striata is sometimes inherited in an [[autosomal dominant inheritance|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.<ref>{{cite web|url=http://www.emedicinehealth.com/script/main/art.asp?articlekey=110224|title=Pictures of Nail Diseases and Problems - Leukonychia Striata|publisher=}}</ref>
-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.<ref>{{cite journal|last=Huang|first=T.-C.|author2=Chao, T.-Y. |title=Mees lines and Beau lines after chemotherapy|journal=Canadian Medical Association Journal|date=14 December 2009|volume=182|issue=3|pages=E149–E149|doi=10.1503/cmaj.090501}}<!--|accessdate=14 July 2012--></ref>
-====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.<ref name="jtad.org"/> 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 months, which is the amount of time necessary for nails to regrow completely. The pattern and number of spots may change as the nail grows.<ref>{{cite web|url=http://www.salongeek.com/health-safety-unatural/6245-my-big-fat-greek-leukonychia.html|title=My Big Fat Greek Leukonychia|publisher=}}</ref>
-====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]].<ref name="jtad.org"/>
-==Diagnosis and treatment==
-A doctor will take a thorough [[medical history]], and may take blood tests as well as examining [[liver]] and [[kidney]] function. Some physicians believe it is a sign of [[zinc deficiency]].<ref>Kelly MP, Kight MA, Castillo S. ''Adv Ren Replace Ther''. 1998 Jul;5(3):241–51. "Trophic implications of altered body composition observed in or near the nails of hemodialysis patients."</ref> Intracellular (red blood cell) assays are more sensitive than tests for plasma levels.
 ==References==
-{{reflist|30em}}
+{{Reflist}}
-==External links==
+== External links ==
+{{Medical resources
+|  DiseasesDB     = 14140
+|  ICD10          = {{ICD10|L|60|8|l|60}}, {{ICD10|Q|84|4|q|80}}
+|  ICD9           = {{ICD9|703.8}}, {{ICD9|757.5}}
+|  ICDO           =
+|  OMIM           =
+|  MedlinePlus    =
+|  eMedicineSubj  =
+|  eMedicineTopic =
+|  MeshID         =
+}}
 {{Commons category|Leukonychia}}
-* [http://www.straightdope.com/classics/a3_035.html What causes white spots on your fingernails?] at [[The Straight Dope]]
-* {{GPnotebook|-234487799}}
-* {{DermAtlas|129}}
-<!--Leukonychia is not actually a "disease," but it's unclear where else to categorize this article.-->
 {{Disorders of skin appendages}}

v t e Congenital malformations and deformations of skin appendages
Nail disease	Anonychia Leukonychia Pachyonychia congenita/Onychauxis Koilonychia
Hair disease	hypotrichosis/abnormalities: keratin disease Monilethrix IBIDS syndrome Sabinas brittle hair syndrome Pili annulati Pili torti Uncombable hair syndrome Björnstad syndrome Giant axonal neuropathy with curly hair hypertrichosis: Zimmermann–Laband syndrome