Leukonychia - A Detailed Approach

Introduction

Nails are naturally pinkish. A white nail represents the appearance of one or more fingernails and toenails that are partially or entirely white. This appearance is also called leukonychia. Nail color changes can provide essential hints of underlying systemic and skin disease. In distinct, white discoloration (leukonychia) has a high majority with a vast potential relevant cause, from simple manicure routines to life-threatening liver or kidney failure. Therefore, a reliable estimation of the patient with leukonychia is essential. Leukonychia has two classifications. The morphological categorizes the nail according to the white line distribution, including

• Total leukonychia.

• Partial leukonychia.

• Transverse leukonychia, such as Mees’ and Muehrcke’s lines.

• Longitudinal leukonychia.

Terry's and Lindsay's nails are examples of total and partial leukonychia.

The anatomical classification is based according to the structure of the white color:

• The nail plate in true leukonychia.

• The nail bed is apparent leukonychia.

• The surface only in pseudo leukonychia.

Morphological and anatomical features have been combined to help clinicians approach leukonychia efficiently and effectively.

What Is Leukonychia?

Leukonychia also termed white nails, is usually not a bad sign, but it can unmask severe systemic diseases or congenital disorders. In addition, the white color can occur due to nail plate or nail bed anomalies. Distinguishing between these two is vital in the classification and understanding of leukonychia.

In 1896, Unna classified leukonychia into three morphologic presentations:

• Total.

• Striate (transversal and longitudinal).

• Punctate.

Weber classification. Besides the morphological classification, leukonychia can be divided into three anatomical types.

• True leukonychia, no color fading in pressure.

• Apparent leukonychia, fading in nail bed on pressure.

• Pseudo-leukonychia, superficial scaling in the nail bed.

What Causes Leukonychia?

Various causes cause Leukonychia. Leukonychia has no gender predominance and can be seen in people of any age. Some of the reasons are mentioned below.

Trauma

• True Leukonychia: Partial or complete nail plate damage induced by nail plate or matrix injury. Keratin disruption caused by trapped air within the nail plate, resulting in reflection and opacity.

• Punctate Leukonychia: This happens as a result of nail biting, manicure, knocks and bangs, and wearing tight footwear.

• Striate Leukonychia: Also known as Mees lines or transverse leukonychia, can occur after nail matrix degradation; furrows and ridges may form.

• Total Leukonychia: This condition can occur after a more significant injury, and it is characterized by the separation of the nail plate from the nail bed and changes in the nail contour.

Injury types causing nail damage are mentioned below.

• Nail-biting habit.

• Manicures.

• Day-to-day nail injuries.

• Small footwear causes increased abnormal pressure on the nails.

Poisoning and Drugs

However, this cause is somewhat rare and usually results in transverse leukonychia.

Poisoning and medication can result in white areas on or under the nails.

• Heavy metals such as lead and arsenic poisoning from metals.

• Chemotherapy treatment for cancer.

• Sulfonamides treat bacterial infections, including skin infections, septicemia, and urinary tract infections.

Systemic Cause

Systemic diseases can be a rare cause of white nails.

Some of the systemic diseases are mentioned below.

• Iron deficiency anemia.

• Liver cirrhosis.

• Kidney disease.

• Heart failure.

• Diabetes mellitus.

• Abnormal digestion of proteins.

• An excessive protein loss in the intestines.

• Zinc deficiency.

• Hyperthyroidism.

• Psoriasis.

• Eczema

• Fungal disease caused by Trichophyton interdigitale.

Hereditary Causes

• Bart-Pumphrey syndrome, which includes nail problems, knuckle issues, and deafness.

• Buschkell-Gorlin syndrome is characterized by skin cysts, nail problems, and kidney stones.

• Bauer syndrome, causing nail problems and skin cysts.

• Darier disease, which shows wart-like blemishes on various body parts.

How to Diagnose Leukonychia?

Leukonychia can be diagnosed with various diagnostic tools. Dermatoscopy is used to assess nail changes. Nail color changes are evaluated with an ultrasound gel. However, the signs of leukonychia are similar to onycholysis. Therefore, the features must be distinguished between leukonychia and onycholysis. If the cause of leukonychia is unclear, the following tests may be helpful.

• Nail clippings for mycology to rule out fungal infection.

• Nail biopsy.

• Blood tests: To assess systemic conditions and low albumin levels.

• Potassium hydroxide or a superficial scraping culture helps confirm onychomycosis.

• Neurologic tests such as electromyography.

How to Treat Leukonychia?

The treatment of leukonychia is primarily done to manage the symptoms. In leukonychia with systemic disease, the underlying cause must be treated. However, leukonychia can be managed by the following methods.

• Gentle nail care.

• Avoid manipulating cuticles.

• Limit the application of frequent irritant or allergic grooming products such as nail polish, artificial nails, remover, and nail glue.

• Frequent moisturizer application can be beneficial.

• Avoid trauma.

• In pseudo leukonychia due to fungi, antimycotic therapy is suggested.

Some preventive measures can be followed to avoid white nails. Preventive steps include:

• Avoiding contact with irritant substances.

• Avoiding excessive nail polish use.

• Cutting nails short.

• Stopping the nail's dryness by using a moisturizer after washing.

Home remedies are readily available to get healthy nails. For example, excess use of nail polish remover causes nail dryness and changes the nail color to yellow. Some of the home remedies to get healthy nails are mentioned below.

• Tea tree oil has antifungal and antibiotic properties.

• Lemon juice and baking soda.

• Coconut oil.

• Garlic.

• Cider vinegar.

• Biotin supplements can be taken.

• Drinking a sufficient amount of water.

• A healthy nutritional diet must be taken.

• Hand sanitizer can be used to avoid infections.

• Avoid using gel or acrylic nails.

• Do not use nails as a tool.

• Sea salt can be used to strengthen nails.

• Vitamin E can improve nail health.

• Nails can be soaked with lemon juice and olive oil.

• Shea butter can support and nourish the nails. It restores moisture and promotes the growth of strong nails.

What is the outcome of Leukonychia?

Leukonychia caused by minor trauma or medicine may recover entirely within a few months. In some circumstances, the white nail plate may persist indefinitely or recur.

Conclusion

Leukonychia is the whitening of nails due to various causes. Leukonychia is of various types. Trauma, systemic diseases, and other allergens can cause leukonychia. A dermatoscopy is done to diagnose leukonychia. One of the differential diagnoses of leukonychia is onycholysis. In systemic diseases, underlying causes must be treated. Some of the preventive measures are followed to prevent and manage leukonychia. Self-care routines and a healthy diet is followed to get healthy nails.