Liam Carter
The ends of our nails are white because nails are naturally white-transparent. The nail is joined to the finger underneath, so we see the colour of the finger through the nail. The end of the nail is detached from the finger, so we see the colour of the nail there. White spots on nails, known as leukonychia, are usually harmless and are often caused by injury to the nails, such as biting them or hitting them against a hard surface. In rare cases, white spots on nails can be a symptom of a more serious condition.
| Characteristics | Values |
|---|---|
| General cause | Nails are naturally white-transparent, but most of the nail is joined to the finger underneath it, so you see the colour of the finger through the nail. The end of the nail is detached from the finger, so you see the colour of the nail there. |
| Scientific cause | The white half-circle at the base of your nail is called the lunula. The lunula looks white because the epidermis is thicker beneath the matrix (the area where your nails grow from), and it blocks the pink colour from the blood vessels below. |
| Medical cause | White nails, also known as leukonychia, may be a marker of an underlying systemic disease. |
| Harmless cause | White spots on nails are usually harmless and are generally caused by an injury, such as striking the fingertip or repeated trauma to the nails from frequent manicures. |
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What You'll Learn
Nails are naturally white-transparent
The white colour at the ends of nails is due to nails being naturally white-transparent. Most of the nail is joined to the finger underneath, so you see the colour of the finger through the nail. The end of the nail is detached from the finger, so you see the colour of the nail itself, which is white-transparent. This white half-moon shape at the base of your nail is called the lunula. The lunula appears white because the epidermis is thicker beneath the matrix (the area where nails grow from), and it blocks the pink colour from the blood vessels below.
The white colour of the lunula is not always due to nails being naturally white-transparent. It can also be caused by leukonychia, which is the partial or full discolouration of the nail plate on one or more fingernails or toenails. The nail loses its general pink undertone and appears white. There are three types of leukonychia: true, apparent, and pseudoleukonychia. True leukonychia occurs when there is damage to the nail plate or matrix, causing trapped air within the nail plate, resulting in reflection and a lack of transparency. Apparent leukonychia occurs when the white spots form in the skin on which the nails rest (nail bed). Pseudoleukonychia occurs when white spots form on the surface of the nail due to external factors, such as fungi.
White spots on the nails are usually harmless and are generally caused by an injury, such as striking the fingertip or repeated trauma to the nails from frequent manicures. Other potential causes include zinc or calcium deficiency, fungal infections, or allergic reactions. White spots on the nails can also be caused by low oxygen levels in the blood, which can be a sign of heart disease or emphysema. In rare cases, white spots on the nails can be a symptom of a more serious condition. If white spots appear on the nails alongside severe symptoms, it is recommended to consult a healthcare provider.
Nail abnormalities can also be a sign of an underlying condition. For example, white nails can be a marker of an underlying systemic disease. Curved or "clubbed" nails can be associated with lung disease, inflammatory bowel disease, cardiovascular disease, or liver disease. Thick, overgrown nails can be hereditary or caused by conditions such as psoriasis or poor blood circulation. Separated nails can be linked to psoriasis or other illnesses. Dark lines that appear beneath the nail could be caused by melanoma, a serious type of skin cancer.
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White nails may indicate an underlying condition
White nails, also known as leukonychia, are usually harmless and acquired or congenital. They are often caused by an injury, such as striking the fingertip or repeated trauma to the nails from frequent manicures. However, in rare cases, they can indicate an underlying condition.
If you notice white nails alongside more severe symptoms, it is important to consult a healthcare professional. White nails can be a marker of an underlying systemic disease, and a thorough physical examination and medical history may be sufficient for diagnosis. Blood tests can also be performed to evaluate systemic disease, particularly renal and liver function tests.
One type of white nails is known as Muehrcke lines, which are a pair of observable, horizontal white lines across the nail due to variable blood flow. This type of white nail may be associated with hyperthyroidism or hypoalbuminemia.
Another type of white nails is Terry nails, where the majority of the nail is whitened with a thin distal darkening. This can be seen in individuals with Darier disease or Hailey-Hailey disease. White nails can also be associated with lung disease, inflammatory bowel disease, cardiovascular disease, or liver disease.
In some cases, white nails may be caused by a fungal infection, zinc or calcium deficiency, allergic reactions, or poor circulation. It is always important to monitor any changes in your nails and seek medical advice if you are concerned or if the changes are accompanied by other symptoms.
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White spots on nails are usually harmless
The white half-moon shape at the base of the nail is called the lunula. This area is white because the epidermis is thicker, blocking the pink colour from the blood vessels below. The rest of the nail appears pink because it is pressed against the finger, and you are seeing the colour of the finger through the nail. When the nail is no longer touching the skin, you are seeing the natural colour of the nail, which is white-transparent.
In rare cases, white spots on nails can indicate a more serious underlying condition. For example, white nails can be a marker of an underlying systemic disease, such as liver disease or lung disease. White lines on the nails, known as Muehrcke lines, may be associated with hyperthyroidism or hypoalbuminemia. If white spots on the nails are accompanied by other severe symptoms, it is important to consult a healthcare professional.
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White nails can be congenital
White nails, also known as leukonychia, are typically milky/chalky/porcelain white. Leukonychia can be acquired or congenital. Congenital leukonychia may improve over an individual's lifetime, sometimes improving with age, but not always. This improvement is related to the maturation of cells that start producing normal keratins and losing the keratohyalin granules.
Familial leukonychia is more commonly inherited recessively, although dominant patterns are possible. This is due to a mutation in the phospholipase C delta-1 gene, where all nails appear white. An autosomal dominant pattern of inheritance is most frequent, but an autosomal recessive pattern has also been reported. In publications reporting on idiopathic congenital true leukonychia, all patients were male, with only one exception. This exception is challenging to explain, but it could be due to Y-chromosomal inheritance with variable penetrance.
Congenital leukonychia may also be secondary to systemic disease. It is important to note that congenital leukonychia may warrant a work-up for systemic disease. Hereditary leukonychia may exist in isolation or in association with other cutaneous or systemic pathologies.
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White nails can be caused by injury
White nails, or leukonychia, can be caused by injury to the nail plate or nail matrix. This is the most common cause of white spots on nails. The nail matrix is the base of the fingernail that produces the nail plate. An injury to this area can cause white spots on the nail as it grows.
Injuries that can cause leukonychia include bumping or hitting your nails, wearing shoes that are too small, biting your nails, or even getting manicures. Manicurists may use a lot of force to trim, buff, and polish your nails, which can injure the nail plate or matrix. Additionally, repeatedly hitting your nails against a hard surface, such as accidentally closing your finger in a car door or striking your finger with a hammer, can also cause leukonychia.
In most cases, the white spots caused by injury will eventually grow out, and you will be able to clip or cut them off. Fingernails typically take six to nine months to grow out fully, while toenails can take up to 18 months. During this time, the white spots may disappear entirely as the nail follows its natural growth pattern. However, it is important to protect your nails and prevent further injury by wearing protective gloves and shoes and avoiding activities that may cause your nails to be pinched, hit, or smashed.
While leukonychia due to injury is generally harmless, it is important to monitor your symptoms and seek medical advice if needed. In rare cases, white spots on nails can be a symptom of a more serious condition or underlying pathology, such as systemic disease or mineral deficiency. Therefore, if the white spots on your nails are not improving or are accompanied by other symptoms, it is recommended to consult a healthcare professional for further evaluation and treatment.
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Frequently asked questions
Nails are naturally white/transparent, but most of the nail is joined to the finger underneath it, so you see the colour of the finger through the nail. The end of the nail is detached from the finger, so you see the colour of the nail there.
White nails are generally harmless and are usually caused by an injury, such as striking the fingertip or trauma to the nails from frequent manicures. However, they can sometimes be a sign of an underlying condition, so it's best to see a doctor if you're concerned.
Other potential causes of white nails include zinc or calcium deficiency, fungal infections, allergic reactions, or low oxygen levels in the blood.
