What is a White Nail Syndrome & How is it Treated?|Types, Causes of White Nail Syndrome or Leukonychia

White nail syndrome is a rare condition and is often associated with other systemic diseases. White nail syndrome is also called leukonychia. White nail syndrome can be total or partial. Total leukonychia refers to a condition where the whole nail plate is totally white in color. The color of the entire nail bed changes to white color. Sometimes, leukonychia is confused with leukoderma.

The White Nail Syndrome is not dependent on age, sex or gender. Any person of any age can have leukonychia and it usually disappears as the nail grows. Another type of Leukonychia is partial leukonychia where the nail bed shows different patterns. White spots on the nail are known as punctate leukonychia, which is a type of partial leukonychia. White Nail Syndrome or Leukonychia can occur because of arsenic poisoning, heart disease, renal failure and pneumonia.

There are three main types of partial white nail syndrome or partial leukonychia seen in various individuals:

1. Punctate Leukonychia

   Punctate leukonychia is the most common type of the white nail syndrome pattern found and can occur in any individual. In this type of white nail syndrome, the nail plate gets small white spots on the nail bed and eventually disappears when the nail grows. The reason for its appearance can also be trauma or abnormal keratinization.

   Punctate leukonychia is also caused by trauma. While the white spots appear on the nail bed, they might grow into large or small white spots depending on the pattern of nail growth.

2. Longitudinal Leukonychia

   Longitudinal Leukonychia is presented as a white band on the nail bed. Sometimes, this type of white nail syndrome is associated with Darier’s disease. The size of these lines can be up to 1 mm or more depending from one person to another.

3. Striate or Transverse Leukonychia

   Striate Leukonychia is presented as one or more horizontal lines all over the nail bed. These lines are also called Mees’ lines. It appears more commonly in the fingernails of women, after manicure or pedicure. This type of partial white nail syndrome or partial leukonychia may also occur in big toenails of both males and females because of the trauma from the shoes.

   There are two other types of White Nail Syndrome as well:

True leukonychia is when the white spots or lines have appeared on the nail bed because of any trauma to the nail. These white spots or lines disappear as the nail grows. These lines of leukonychia are not affected when pressure is put on them by pressing the nail.

When the area under the nail bed is affected because of the color of the nail then it is known as apparent leukonychia. In this type of leukonychia, the color of the nail is reflected as white or pink and the color disappears when pressure is put on the nail with some external force or by the other fingernail. This type of leukonychia will lessen or disappear under pressure and will not grow out with the nail.

There are different causes of White Nail Syndrome or Leukonychia, which may vary from one person to another. Various factors responsible for the occurrence of White Nail Syndrome are discussed below:

Trauma to the nail because from any external factor is the most common reason for the development of White Nail Syndrome or Leukonychia. Nail injury leads to this pattern of White Nail Syndrome and is very common in children.

Various activities that can cause this kind of injuries or trauma include manicure, pedicure, excessive nail biting, wearing a smaller size of footwear which hurts the big toe, keeping large nails and wearing tight shoes or any other kind of nail injuries may result in trauma to the nail and appearance of white nail syndrome.

There are several underlying systemic diseases, which can be responsible for the occurrence of white nail syndrome or Leukonychia. There are certain diseases, which can lead to white nail syndrome such as:

• Anemia.
• An overactive thyroid gland or hyperthyroidism.
• It can also happen in people who have the inability to digest proteins.
• People with diabetes are also prone to develop this nail disorder.
• People who are suffering from any heart diseases are at risk of getting white nail syndrome.
• People with certain skin diseases like psoriasis and eczema also lead to the appearance of white nail syndrome or leukonychia.
• People who have kidney diseases are also more prone to having white nail syndrome than normal people.
• Also, the people with certain liver disorders like cirrhosis of the liver are also prone to getting Leukonychia.
• A specific infection of the nails or particularly fungal infection can also lead to the appearance of white nail syndrome or Leukonychia.

Genes can also play an important role in the appearance of white nail syndrome or Leukonychia. Genes carrying the trait of white nail syndrome can be transmitted from generation to generation and can result in the appearance of white nail syndrome. There are certain rare and complex syndromes associated with white nail syndromes like Bauer syndrome, Darier disease and Bart-Pumphrey syndrome.

There are certain drugs or medicines which lead to the development of white nail syndrome or Leukonychia in certain individuals. These medicines can lead to the appearance of white nails or lead to the formation of a white nail bed and include:

• These medications include chemotherapy drugs which can be injected, given orally or infused into the skin to kill the cancer cells in the body. These drugs lead to the appearance of white nails.
• Another medication/drug, which can cause Leukonychia, is sulphonamides, a medication used for bacterial infections, such as skin infections, septicemia, and infections of the urinary tract.

The treatment of White Nail Syndrome depends on the underlying cause. When you visit your doctor for treatment of White Nail Syndrome, doctor will ask you certain questions related to other factors, which result in the occurrence of white nail syndrome or Leukonychia. The doctor might prescribe some diagnostic tests to rule out the presence of any severe systemic disease before giving any medication to treat white nail syndrome. Tests, which are done to rule out any systemic diseases as a cause of white nail syndrome, are:

• Blood tests to rule out the presence of any infection in the blood or any other systemic disease.
• Nail biopsy wherein the lab technician will take a little sample of your nail to test it for various anomalies or any infection to the nail.
• Mycology is another examination where a sample of nail is tested for the possibility of any fungal infection.
• Otherwise, there is no specific treatment for the white spots on the nails, as they will eventually disappear once the nail grows. If there is no underlying infection/disease, white nail syndrome or Leukonychia will disappear as stated before.