What Dermatologists Want You to Know About White Spots on Your Nails
Broken and brittle nails are not uncommon, but if you’re seeing white spots on your nails, also known as leukonychia, it’s understandable to be concerned.
“Leukonychia is a condition where people get these white dots or lines on their fingernails,” says Karan Lal, D.O., M.S., F.A.A.D., double board-certified dermatologist with Affiliated Dermatology in Scottsdale, AZ. “The most common cause of this is trauma, but it can also be associated with various medical conditions.”
Meet the experts: Karan Lal, D.O., M.S., F.A.A.D., double board-certified dermatologist with Affiliated Dermatology in Scottsdale, AZ; and Brendan Camp, M.D., a double board-certified dermatologist in dermatology and dermatopathology at MDCS Dermatology
Here, experts explain exactly what to know about white spots on nails—including the most common causes and effective treatments.
What is leukonychia
“The prefix leuko means white and the term nychia refers to nails,” explains Brendan Camp, M.D., a double board-certified dermatologist in dermatology and dermatopathology at MDCS Dermatology. There are a few main types of leukonychia, including:
Apparent leukonychia: These white spots appear on the nail bed (under the nail) and disappear when pressure is placed on the nail, Dr. Camp says.
True leukonychia: These white spots originate from the nail matrix (where your nail grows) and appear on the nail plate, says Dr. Lal. These spots do not disappear with pressure.
Pseudoleukonychia: These white spots appear as flaking on top of the nail and are most often caused by fungi, says Dr. Lal.
Causes of white spots on nails
The presence of white spots on your nails can mean a number of things. Experts say the discoloration is most commonly due to injury and is usually not a major cause for concern. However, certain conditions may be associated with white spots or lines on the nail, such as:
Fungal infection
“Some fungal infections can cause a white discoloration of the nail plate as opposed to the more traditional yellow color associated with fungal infections,” explains Dr. Camp. A specific type of fungal infection called superficial white glycomycosis is one that Dr. Lal says he often sees, which is characterized by “white flaking on the top of the fingernail.”
Psoriasis
Dr. Lal says that psoriasis (an autoimmune condition affecting the skin) can cause leukonychia. It can also cause something called onycholysis, “which is when the nail plate separates from the nail bed and causes the formation of white spots,” says Dr. Camp.
Trauma
Trauma to the nail from some type of injury can lead to white discoloration, explains Dr. Camp. This can be from hitting your nail on a hard surface, getting your nail caught on something, or biting your nails. Dr. Camp also notes that manicures and pedicures may also cause white spots on nails due to the tools, polishes, and chemicals used during the service.
Medications
Certain medications have the potential to cause white spots on your nails as well. Dr. Lal says the most common medications that can do this are chemotherapy drugs and long-term antibiotics such as sulfonamides.
Underlying medical conditions
“There are other forms of leukonychia that can be associated with internal conditions, such as liver disease, kidney disease, and even heart failure,” Dr. Lal explains. He specifically mentions something called “half and half nails” in which half the nail (horizontally) is entirely white, which may be an indicator of kidney disease. Dr. Lal also points to Muehrcke’s lines, which are characterized by transverse or longitudinal white lines that run across the nail and may mean a deficiency in albumin protein.
“When things look more uniform...those are concerning signs in terms of a possible medical condition,” Dr. Lal says. Other skin conditions like alopecia areata, lichen planus, and atopic dermatitis can also cause white spots on the nails, Dr. Camp adds.
White spots on nails treatments
Protect your nails
“Trauma-related leukonychia will usually grow out with the nail plate over time,” says Dr. Camp. While you allow these white spots to diminish, protect your nails from further trauma by keeping them trimmed short (to avoid bumping and snagging), and try not to over-file or buff your nails. “Anything that’s going to damage the nail plate could theoretically cause leukonychia,” says Dr. Lal. “Try not to tap your nails often, don’t pick at your nails, and don’t bite at your nails.” You can also try using nail strengtheners and cuticle oil to keep your nails strong and healthy.
Antifungal medications
If your doctor determines that you have a fungal infection causing the white spots, they prescribe an antifungal treatment (if over-the-counter options do not work), explains Dr. Camp.
Systemic therapy
For certain conditions like psoriasis, systemic therapy is often needed as “psoriatic nails are difficult to treat with topicals,” says Dr. Camp. The type of psoriasis treatment (likely a medication) your dermatologist selects for you will depend on your unique symptoms, lifestyle factors, and other medical conditions or medications.
Tests to diagnose white spots on nails
Nail scraping
Your doctor may scrape your nails to rule out a superficial fungal infection, which Dr. Lal says is “quick, effective, and easy” to perform in the office.
Nail biopsy
“Very rarely, we will do a nail biopsy, but that’s not very common,” says Dr. Lal. To perform a biopsy your doctor will use a scalpel to gather skin cells from your nails and send them to a laboratory for testing.
Full physical exam
Dr. Lal says that the main thing to consider when it comes to the nails is potential underlying causes. The best way to do this is to conduct a full physical exam, which involves your doctor looking at your fingers and toes and potentially ordering a comprehensive blood panel.
When to see a doctor for white spots on your nails
If you’re worried, it’s always best to consult your physician. “White spots can be an indication of underlying medical disorders or infection. If they do not grow out with the nail and disappear or do not respond to over-the-counter treatment, see a board-certified dermatologist for evaluation,” explains Dr. Camp
Additionally, if you notice any other symptoms such as swelling, changes in color, or a uniform appearance of white spots on your nails, Dr. Lal encourages you to see your dermatologist.
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