Isla Bennett
The whitish part of the nail, known as the lunula, is the visible part of the matrix, the whitish crescent-shaped base of the nail. The lunula is usually most noticeable on the thumb, but not everyone's lunulae are visible. While some changes to the nail are harmless, others may indicate an underlying disease. For example, a change in the colour or size of the lunula may signal an underlying disease, and in some cases, its absence may indicate an underlying health problem.
| Characteristics | Values |
|---|---|
| Name | Lunula |
| Description | A white, crescent-shaped base of the nail |
| Cause of colour | Reflection of light at the point where the nail matrix and nail bed meet; thickened underlying stratum basale obscures underlying blood vessels |
| Location | Most noticeable on the thumb; may not be visible on the little finger |
| Associated conditions | Cirrhosis, chronic renal failure, congestive heart failure, Wilson's disease, heart failure, severe kidney disease, melanoma, diabetes, cancer treatment, exposure to cold temperatures, Raynaud's disease, cardiovascular and pulmonary problems, gastrointestinal problems, iron-deficiency anemia, hemochromatosis |
| Diagnosis | Dermoscopy, blood tests, renal and liver function tests |
| Treatment | Moisturisers to hydrate nails |
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What You'll Learn
- The whitish part of the nail is called the lunula
- Leukonychia, or white nail, is the partial or full discolouration of the nail plate
- White nails may be a marker of an underlying systemic disease
- Dermoscopy is a useful tool to integrate the clinical examination of minor alterations to the nail
- Changes in nail shape and surface can also signal a health issue
The whitish part of the nail is called the lunula
The lunula's location on the newest part of the nail allows for assessments about one's health. A change in colour or size of this feature may indicate an underlying disease. For example, if the lunula extends almost to the end of the nail, it could signal cirrhosis, chronic renal failure, or congestive heart failure. This condition, called Terry's nails, is characterised by a reddish or brown distal band of less than 20% of the nail. Terry's nails can also be attributed to ageing. Lunulae with a bluish tint could suggest Wilson's disease, a rare inherited genetic disorder in which copper accumulates in the liver, brain, and other organs. Red lunulae may indicate heart failure, and in patients with severe kidney disease, it is common to see half-and-half nails, where the white from the lunula extends halfway up the nail bed, and the other half is darker.
White nails, or leukonychia, can be a cosmetic nuisance but may also indicate an underlying systemic disease. Leukonychia can be classified as either true or apparent discolouration. True leukonychia is caused by abnormal nail plate keratinisation, while apparent leukonychia is secondary to disease in the nail bed. Apparent leukonychia can be further subdivided into three types: Muehrcke lines, which may be associated with systemic disease; Lindsay's nails, or half-and-half nails, which are detected in patients with chronic renal disease; and punctate leukonychia, which occurs after nail biting, manicuring, knocks, tight footwear use, or other minor trauma.
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Leukonychia, or white nail, is the partial or full discolouration of the nail plate
True leukonychia refers to discolouration caused by abnormal nail plate keratinisation, resulting in damage to the nail plate or matrix. This type of discolouration cannot be hidden by applying pressure to the nail plate. On the other hand, apparent leukonychia is secondary to a disease of the nail bed and can be concealed by applying pressure to the nail.
Leukonychia can be further subdivided into partial and total leukonychia. Total leukonychia involves the whitening of the entire nail plate, while partial leukonychia has three subtypes: Striate, punctate, and transverse leukonychia. Striate leukonychia, also known as Mees lines or transverse leukonychia, may follow damage to the nail matrix and can result in the appearance of furrows and ridges on the nail. Punctate leukonychia occurs after nail biting, manicuring, knocks, tight footwear, or other minor traumas.
While white nails are often a cosmetic concern, they may also indicate an underlying systemic disease. Changes in nail colour can provide important clues about potential health issues, and a thorough examination by a healthcare professional is recommended to determine the cause. Dermoscopy, for example, is a valuable technique used to facilitate the clinical diagnosis of nail disorders and can help distinguish between different types of leukonychia.
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White nails may be a marker of an underlying systemic disease
The presence of white nails may warrant a check-up for systemic disease. Leukonychia, the medical term for white nails, can be classified by its underlying pathology, its distribution, or how it develops. True leukonychia is partial or whole nail plate damage caused by injury to the nail plate or matrix. This results in keratin disruption with trapped air within the nail plate, leading to reflection and a lack of transparency.
Apparent leukonychia is secondary to disease of the nail bed. This type of leukonychia disappears with pressure application on the nail. There are three distinct types of apparent leukonychia that may be associated with systemic disease: Muehrcke lines, half-and-half nails, and Terry's nails. Muehrcke lines are a pair of observable, non-palpable lines. Half-and-half nails, also known as Lindsay's nails, are characterized by a sharply demarcated red, pink, or brown discoloration of 20-60% of the distal nail bed, leading to two-colored nails with a transverse border. Terry's nails are characterized by subtotal apparent leukonychia with a reddish or brown distal band of less than 20%.
White nails can also be caused by minor trauma or medication and may completely resolve over a few months. However, in some cases, the white nail plate may remain permanently or recur. While white nails may be a cosmetic nuisance, they can be a marker of an underlying systemic disease. A thorough history and physical examination may be sufficient for diagnosis. Blood tests can also be performed to evaluate systemic disease, particularly renal and liver function tests.
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Dermoscopy is a useful tool to integrate the clinical examination of minor alterations to the nail
The whitish part of the nail, also known as leukonychia, is the partial or full discolouration of the nail plate on one or more fingernails or toenails. It is the most common type of nail dyschromia. While it can be a cosmetic nuisance, it may also indicate an underlying health problem.
Dermoscopy is a valuable tool that can be used to integrate the clinical examination of minor alterations to the nail. It is a non-invasive diagnostic method that can be applied to all visible parts of the nail unit, including the nail matrix, to evaluate skin lesions and nail disorders. It is particularly useful for the diagnosis of nail pigmentation issues, such as melanonychia and chromonychia, and for assessing nail tumours. The procedure can be performed dry or with moisturisers to hydrate nails.
When used in conjunction with clinical examination, dermoscopy can help to reach a diagnosis by magnifying and enhancing the visualisation of symptoms. The nail is typically observed at ×10 magnification, but moving to higher magnifications of ×20 to ×70 and moving the lens back and forth and transversally can improve observation.
Dermoscopy has been found to be especially useful in the diagnosis and treatment follow-up of nail infections caused by Pseudomonas aeruginosa and Candida albicans. It can help distinguish between melanocytic melanonychia and nail infections caused by haematomas, which is important to avoid unnecessary biopsies.
In addition to evaluating nail pigmentation, dermoscopy can also be used to assess other nail disorders. For example, it can help identify longitudinal fissures of the nail plate due to lichen planus and dorsal pterygium, as well as the surface alterations associated with trachyonychia or "20-nail dystrophy".
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Changes in nail shape and surface can also signal a health issue
Nails with a blue hue can signal low levels of oxygen in the blood. If the lunula, the white half-moon shape at the base of the nail, has a bluish tint, it could be a sign of Wilson's disease, a rare inherited genetic disorder where copper accumulates in the liver, brain, and other organs. Red lunulae may indicate heart failure. If the lunula extends almost to the end of the nail, making the majority of the nail white, it could signal Terry's nails, which may be a sign of ageing, or of cirrhosis, chronic renal failure, or congestive heart failure.
Beau's lines, or indented horizontal lines on the nail, could be a sign of a previous serious illness, injury, or shock to the body. They may also be a marker of uncontrolled diabetes or the result of cancer treatment or exposure to cold temperatures in people with Raynaud's disease, a rare blood vessel disorder.
If you notice a dark streak that runs the length of the nail, contact your doctor as it could be melanoma, the deadliest form of skin cancer. Melanomas can appear on or around the fingernail, and they don't usually cause other noticeable symptoms, so the colour of your nail could be the only clue to its presence.
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Frequently asked questions
The whitish part of the nail is called the lunula, which is the visible part of the matrix. The lunula appears white due to a reflection of light at the point where the nail matrix and nail bed meet. A change in colour or size of this feature may indicate an underlying disease.
Leukonychia is the partial or full discolouration of the nail plate on one or more fingernails or toenails. It can be classified by underlying pathology, its distribution, or how it develops. True leukonychia is discolouration due to abnormal nail plate keratinisation, whereas apparent leukonychia is secondary to disease of the nail bed.
An abnormal nail shape and nail surface can signal a health issue. For example, "spoon nails" can be a sign of an iron issue, and a nail that curves around an enlarged fingertip, known as clubbing, may suggest cardiovascular and pulmonary problems. If you notice a dark streak that runs the length of the nail, contact your doctor as it could be melanoma.
If you notice an abnormality in your nail(s), it is advised to bring it to the attention of your healthcare provider, especially if you are experiencing any other symptoms.
