Isla Bennett
White toenails, referred to as leukonychia by medical professionals, are a relatively common condition, especially in men. While the condition is usually benign, there are some instances where white toenails can indicate something more serious. The two most common causes of leukonychia are trauma and nail fungus (onychomycosis), which account for over 90% of all cases.
| Characteristics | Values |
|---|---|
| Common Causes | Trauma to the nail, nail fungus, skin conditions like psoriasis or eczema, medications, vitamin or mineral deficiencies, liver disease, kidney disease, hyperthyroidism, protein deficiency |
| Symptoms | White spots, vertical or horizontal lines, ridges, nail turning white and detaching from the nail bed, whitish-yellow brittle nails, nail thickening and crumbling |
| Treatment | For trauma, avoid the cause, wear well-fitting shoes, moisturize the skin around the nail, try over-the-counter products; for nail fungus, use prescription medication like oral or topical anti-fungal treatments |
| Prevention | Avoid walking barefoot in places like locker rooms, ensure proper sanitation of pedicure stations, avoid keeping sweaty shoes and socks on for too long, do not wear nail polish for extended periods, limit exposure to harsh chemicals |
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What You'll Learn
Trauma to the nail
Leukonychia can manifest in several ways. The most common type, true leukonychia, is characterized by white spots developing where the nail starts to grow, known as the nail matrix. Punctate leukonychia is caused by nail biting, frequent manicures and pedicures, and tight footwear, resulting in white spots on toenails. Striate leukonychia creates vertical or horizontal lines across the nail and may cause ridges to appear. Total leukonychia causes the full nail to turn white and often detaches from the nail bed, commonly occurring in foot injuries or for runners with ill-fitting shoes. Pseudoleukonychia refers to white spots caused by fungus or other external factors, which usually clear up once the underlying condition is treated. Apparent leukonychia occurs when the nail whiteness disappears upon applying pressure to the nail bed, indicating a disease of the nail bed.
Nail trauma can cause significant changes to the nail's structure. Common changes include thickening of the nail, nail splitting or ridging, and permanent changes to the nail's growth area, resulting in the toenail never returning to its original shape. In some cases, blood may collect beneath the nail due to a deep cut or tear in the skin beneath, known as a nail bed laceration. This can lead to pain, bleeding, and potential damage to the nail matrix. If severe pain, excessive bleeding, or signs of infection are present, it is crucial to consult a podiatrist or doctor.
To treat leukonychia caused by nail trauma, it is essential to identify and address the underlying cause. Avoiding activities that cause trauma, such as intense exercise or ill-fitting shoes, can help resolve the condition. Choosing well-fitting shoes that provide ample room for the toes and regularly moisturizing the skin around the nail and cuticles can also reduce trauma. Over-the-counter products like Tolvere may be recommended for trauma-related nail discolouration. In some cases, home treatments may be sufficient, but it is always advisable to seek professional advice from a podiatrist or dermatologist to ensure proper healing and prevent complications.
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Nail fungus
White toenails can be caused by a variety of factors, with trauma and nail fungus being the two most common causes, making up over 90% of all cases. Repeated pedicures, injuries, and regular exercise can all cause trauma to the nail, resulting in white toenails. Additionally, skin conditions like psoriasis or eczema, certain medications, and underlying health conditions such as kidney disease or liver disease, can also lead to white toenails.
Fungal nail infections typically occur after an initial trauma to the nail bed, which provides an easier entry point for the fungus. It is important to begin treatment early, as nail fungus can be challenging to eradicate and may take up to a year to clear completely. Topical treatments are usually the first line of defense, but in more advanced cases, oral antifungal medications may be necessary.
To treat nail fungus, it is recommended to give your nails a break from nail polish and avoid using nail polish remover and harsh chemicals that can dry out the nails. Instead, focus on rehydrating your nails by using moisturizers and hand creams to restore moisture balance. Additionally, it is crucial to practice good nail hygiene and avoid walking barefoot in places where fungi may be present.
While leukonychia, or white toenails, is typically benign, it can sometimes indicate a more serious underlying condition. Therefore, if you are experiencing any concerns or symptoms such as swelling, pain, or bleeding around the nails, it is important to consult a dermatologist or podiatrist for proper diagnosis and treatment.
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Skin conditions
White toenails can be caused by a variety of factors, including skin conditions such as:
Psoriasis
Psoriasis is a skin condition that can cause whitish toenails. It is characterised by tiny dents or pits in the affected toenails, yellow or brown discolouration, thick white buildup under the toenail, blood under the nail, crumbling toenails, and toenails that separate from the skin of the nail bed. Approximately 80 to 90 percent of people with psoriasis develop nail psoriasis, although it is possible to have nail psoriasis without exhibiting signs of the skin condition.
Eczema
Eczema is another skin condition that can lead to white toenails. It is important to note that eczema typically presents with other symptoms, such as dry, itchy, and inflamed skin.
Darier Disease
Darier disease is an inherited skin condition that can cause red and white stripes on the toenails. It causes greasy, warty, foul-smelling blemishes on the skin.
Fungal Infections
White toenails can also be caused by fungal infections, such as white superficial onychomycosis, which can cause the toenail to become rough, soft, crumbly, and thickened. This type of fungal infection usually occurs when the toenail is damaged, creating an ideal environment for the fungus to take hold. Proximal subungual onychomycosis is another fungal infection that presents as whitish or yellowish patches starting at the base of the toenail near the cuticle. It is more common in individuals with weakened immune systems.
Leukonychia
Leukonychia is a condition characterised by partial or full discolouration of the nail plate, resulting in white nails. It can be caused by trauma to the nail, such as from pedicures, injuries, or repetitive impact during intense exercises. True leukonychia refers to discolouration due to abnormal nail plate keratinisation, while apparent leukonychia is secondary to a disease of the nail bed.
If you notice white toenails, it is advisable to consult a dermatologist or podiatrist for proper diagnosis and treatment.
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Underlying health conditions
White toe nails can be indicative of underlying health conditions. While white spots on nails are usually harmless and caused by an injury, they can sometimes be indicative of more serious conditions.
White nails are indicative of any or a combination of the following conditions: anemia, overuse of nail polish, weak nails, kidney disease, heart disease, diabetes, rheumatoid arthritis, and liver disease. Whole nail whitening is generally seen in cases of kidney problems, where there is protein deficiency in the body. When whitening is associated with thickened nail plates, the cause could be a fungal infection. Some white spots on nails are indicative of previous trauma to the nail plate.
White nails can also be indicative of leukonychia, which is a common condition that causes white spots or streaks on your fingernails or toenails. There are three types of leukonychia: true leukonychia, apparent leukonychia, and pseudoleukonychia. True leukonychia is partial or whole nail plate damage caused by injury to the nail plate or matrix. Apparent leukonychia is secondary to disease of the nail bed. Pseudoleukonychia is caused by outside organisms, such as fungi. Hereditary conditions, such as Bart-Pumphrey syndrome and Darier disease, may also cause white spots to appear on nails.
In addition, fingernail or toenail abnormalities can sometimes be a sign of underlying health conditions. For example, curved or "clubbed" nails can be associated with lung disease, inflammatory bowel disease, cardiovascular disease, or liver disease. If your toenails look scooped out, it could be a sign of anemia, hypothyroidism, or a range of autoimmune disorders.
If you are concerned about any changes in your nails, it is important to consult a doctor or healthcare provider. They may recommend tests, such as a biopsy or blood test, to help diagnose any underlying health conditions.
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Mineral deficiencies
White toenails, referred to as leukonychia by medical professionals, are relatively common in male patients, with incidence increasing significantly as men age. While men are more prone to this condition, it can also impact women. It is typically a benign condition, but there are some situations where white toenails indicate something more serious, such as mineral deficiencies.
Other causes of leukonychia include trauma to the nail, such as from repeated pedicures, an injury, or regular intense exercise. Skin conditions, like psoriasis or eczema, might also lead to white nails. In rare instances, medications like chemotherapy, protein deficiency, or an underlying health condition, like kidney disease, liver disease, or hyperthyroidism, can cause leukonychia.
Nail fungus, also known as onychomycosis, is one of the most common reasons for white toenails. Nail fungus can be caused by walking barefoot in places like a locker room, improperly sanitized pedicure stations, or constantly keeping your feet covered in shoes and socks. Toenail fungal infections typically present as white or yellow-brown spots under the tip or side of your toenail and, if mild, may resolve on their own. If the toenail fungus progresses, it can cause discoloration, thick white stuff under the toenail (keratin debris), nail thickening, crumbling, and even transmission to surrounding nails.
The treatment for white toenails depends on the cause. For trauma to the nail, avoiding the cause can resolve leukonychia. This may include wearing shoes that fit well and give your toes plenty of room. Regularly moisturising the skin around the nail and your cuticles will help, too. Over-the-counter products for trauma-related nail discolouration can also be used. If the cause is nail fungus, the most effective treatment is a prescription medication, such as an oral or topical anti-fungal.
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Frequently asked questions
White toenails can be caused by a number of factors, including nail fungus, trauma to the nail, mineral deficiency, or skin conditions like psoriasis or eczema. In rare cases, it can be a side effect of medication or a sign of a more serious underlying health condition. It is best to consult a dermatologist or podiatrist to determine the exact cause and receive proper treatment.
The treatment for white toenails depends on the underlying cause. For trauma-related nail discolouration, avoiding the source of trauma and wearing well-fitting shoes can help resolve the issue. Keeping the skin around the nail and cuticles moisturised is also recommended. Over-the-counter products like Tolvere may be effective for nail discolouration. If nail fungus is the cause, prescription medication, such as oral or topical anti-fungal treatments, is typically advised.
Treating white toenails can take several months due to the slow-growing nature of toenails. Early intervention is important to prevent complications and allow for faster resolution.
