Ava Monroe
Changes in nail colour can be indicative of underlying health conditions. One such change is the appearance of white rings on the nails, known as leukonychia. While leukonychia is usually benign, it can sometimes indicate severe systemic disorders or congenital conditions. In this article, we will explore the different types of leukonychia, their causes, and the steps to take if you notice these changes in your nails.
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What You'll Learn
White nails are called leukonychia
Leukonychia can be divided into morphological and anatomical classifications. The morphological classification categorizes the nail according to the distribution of the white lines: total, partial, transversal, and longitudinal leukonychia. Examples of transversal leukonychia include Mees' and Muehrcke's lines, while Terry's and Lindsay's nails are examples of total and partial leukonychia. The anatomical classification, on the other hand, categorizes leukonychia according to the structure responsible for the white color: the nail plate in true leukonychia, the nail bed in apparent leukonychia, and the surface of the nail in pseudoleukonychia.
True leukonychia is caused by intrinsic matrix and plate abnormalities, resulting in a whitening of the entire nail. It is often associated with conditions such as hypoalbuminaemia (low albumin), nephrotic syndrome (kidney failure), liver failure, protein malabsorption, and protein-losing enteropathies. It can also be caused by genetic conditions or as a side effect of certain antibiotics.
Apparent leukonychia occurs when the pathology involves the subungual tissues, resulting in changes to the nail bed that are visible through the nail plate. It is commonly caused by minor injuries, such as nail biting, or may occur during the nail growth process. Patterns of apparent leukonychia include Terry's nails, Lindsay's nails, and Muehrcke's lines.
Pseudoleukonychia, or onychomycosis, refers to the whiteness of the superficial nail plate, often due to external factors such as nail biting, manicuring, tight footwear, or trauma.
While leukonychia is usually harmless, it is important to note that it may sometimes indicate an underlying systemic disease. Therefore, a reliable assessment by a healthcare professional is essential to determine the cause and rule out any serious conditions.
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Mees' lines are white bands that appear across nails
Mees' lines are white lines or bands that appear on the fingernails or toenails. They are parallel with both the cuticles and the white tips of the nails and usually run the entire width of the nail. They can appear on just one nail or all nails at the same time. They are smooth, with no bumps or ridges, and will not fade with pressure.
Mees' lines are often a symptom of an underlying health problem. Historically, they have been associated with arsenic poisoning, but they can also indicate exposure to other heavy metals such as thallium or selenium. They may also be a sign of altitude sickness, carbon monoxide poisoning, chemotherapy, or heart failure. In addition, Mees' lines can be a symptom of kidney failure or liver disease.
If you notice Mees' lines on your nails, it is important to talk to a healthcare professional as they may indicate a serious medical condition. However, if the underlying cause is identified and treated, the Mees' lines will eventually grow out and disappear.
Mees' lines can be confused with Muehrcke lines, which are paired lines that may indicate hypoalbuminemia, liver disease, malnutrition, or nephrotic syndrome. Muehrcke lines fade with pressure and remain in the same place on the nail, whereas Mees' lines move up as the nail grows.
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White nails can indicate liver problems
The appearance of your nails can indicate underlying health issues. While nail abnormalities are usually harmless, white nails, also known as leukonychia, can sometimes be indicative of liver problems.
Leukonychia describes fingernails that are partially or completely white in colour. This condition can be classified both morphologically and anatomically. The morphological classification is based on the distribution of white lines, with types including total, partial, transversal, and longitudinal leukonychia. The anatomical classification, on the other hand, focuses on the structure responsible for the white colour, such as the nail plate in true leukonychia or the nail bed in apparent leukonychia.
True leukonychia is caused by intrinsic matrix and plate abnormalities, resulting in a white appearance that does not fade with pressure. This is because the diffuse reflection of visible light off the nail plate prevents the visualization of the underlying vascularized nail bed. Apparent leukonychia, on the other hand, is caused by pathology involving the subungual tissues, and the colour does fade with pressure as the pressure reduces nail bed edema. Pseudo-leukonychia describes the whiteness of the superficial nail plate due to external factors and also does not fade with pressure.
One specific type of leukonychia, known as Terry's nails, is often associated with liver problems. Terry's nails are characterized by nails that are entirely white, with a thin reddish-brown or pink strip near the tip. This condition is caused by a reduction in blood vessels and an increase in connective tissue in the nail bed. It is commonly seen in people with severe liver disease, cirrhosis, or scarring of the liver. In fact, in a study by Richard Terry in 1954, 82 out of 100 consecutive cirrhosis patients presented with white nails. While Terry's nails do not typically cause any adverse symptoms, they should be evaluated by a doctor as they can be indicative of a more serious underlying health issue.
In summary, while not all white nails are indicative of liver problems, certain types of leukonychia, such as Terry's nails, can be associated with liver disease, cirrhosis, or scarring. If you notice any changes in the colour, shape, or texture of your nails, it is always a good idea to consult with a doctor or dermatologist to rule out any potential underlying health issues.
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Apparent leukonychia is caused by subungual tissue pathology
Leukonychia is the medical term for whitening or apparent whitening of the nail plate. It is usually not an alarming sign, but it can sometimes indicate severe systemic disorders or congenital conditions.
Apparent leukonychia is one of the three types of leukonychia, the others being true leukonychia and pseudo-leukonychia. Apparent leukonychia is caused by subungual tissue pathology, which means that the pathology involves the tissue under the nail. This is different from true leukonychia, which is caused by intrinsic matrix and plate abnormalities, and pseudo-leukonychia, which is caused by external factors such as a fungal infection, nail polish, or psoriasis.
In apparent leukonychia, the whitening of the nail is due to an abnormality of the nail bed. This is why the colour fades with pressure, as pressure results in a temporary reduction of nail bed edema and improved visibility of the underlying nail bed. Apparent leukonychia is often present in only one isolated digit and can be caused by disorders that present with linear erythronychia, such as longitudinal subungual acanthoma and squamous cell carcinoma. It is also a presenting sign of onychopapilloma, a benign nail bed tumour that causes altered light refraction and fibrosis of the nail bed stroma.
Apparent leukonychia can also be caused by changes in the nail bed, such as nail bed edema in lymphoedema, paleness of the nail bed in severe anemia, and cicatricial changes after total skin electron beam irradiation therapy. Selenium deficiency has also been reported as a possible cause of apparent leukonychia in certain populations, such as vegetarians in selenium-deficient areas and patients undergoing long-term hemodialysis or parenteral nutrition.
While leukonychia can sometimes indicate an underlying health issue, it is important to note that many nail abnormalities are harmless and not everyone with white nails has a condition like hepatitis. If you are concerned about the appearance of your nails, it is always best to consult a doctor or dermatologist.
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True leukonychia is caused by intrinsic matrix and plate abnormalities
Leukonychia, or white nails, is usually not a cause for concern but can sometimes indicate severe systemic disorders or congenital conditions. The white colour can be due to nail plate or nail bed abnormalities.
The acquired form of partial and total true leukonychia is often associated with neuropathic disorders, reflex sympathetic dystrophy, autonomic abnormalities, and vascular diseases. It is believed to be caused by a combination of neurovascular deterioration and chronic slow and progressive trauma to the nail matrix due to persistent oedema of the fingers and terminal phalanges. In these cases, the periungual skin is also involved, and the growth rate of the nail plate may be slower.
True leukonychia can be differentiated from other types of leukonychia, such as apparent leukonychia and pseudoleukonychia, through simple tests. Unlike apparent leukonychia, true leukonychia does not fade with pressure because the abnormality is within the plate rather than the nail bed. Additionally, in true leukonychia, the white colour moves distally with nail plate growth, whereas it stays in the same place in apparent leukonychia.
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Frequently asked questions
A white ring on your nails could be indicative of leukonychia, which is the medical term for white spots or bands on nails. It can be further classified into true leukonychia, apparent leukonychia, and pseudoleukonychia. While it is usually benign, in rare cases, it could be a sign of an underlying health condition.
True leukonychia refers to spots on the nail plate itself, whereas apparent leukonychia refers to spots that seem to be on the nail but are actually on the nail bed skin underneath.
A simple test to differentiate between the two is to press on the nail. If the white spot stays, it is true leukonychia, which is generally not a cause for concern. If the whiteness disappears or changes color, it is apparent leukonychia, which could indicate a more serious health issue.
True leukonychia could be caused by trauma to the nail or, in rare cases, poisoning from substances like arsenic or other heavy metals.
Apparent leukonychia might be related to underlying health problems like kidney, liver, or heart issues. It can also be caused by conditions such as hypoalbuminemia, malnutrition, or nephrotic syndrome.
