What you need to know about those white spots on your nails

Don’t panic if you’ve just looked down at your nails and seen they’re covered in white spots. 

White spots on your nails are actually quite common and is usually not a sign of anything sinister.

They also have nothing to do with your sex, age or ethnicity and can happen to anyone.

But if you find them unsightly, there are a number of preventative measures you can take to avoid them, as well as treatment.

Usually both finger and toenails are pale pink in colour with a lighter crescent shape where the bottom of the nail meets your actual finger.

This crescent shape is known as the lunula.

When white spots appear on your nail, this is known as punctate leukonychia.

Don’t worry, we were unsure how to say it as well but it’s actually pronounced loo-koh-nih-kee-yah. 

Try saying that three times fast!

Now that you’ve got the pronunciation down, you’re probably wondering, what the heck is it? And how do I get rid of it?

Well, total leukonychia refers to a condition where the whole nail plate is completely white in colour.

There’s also partial leukonychia which has three main types: 

• Punctate, which manifests as small white spots; 
• Longitudinal, which presents itself as a white band down the nail; and
• Striate or transverse, which is when one or more horizontal lines appear across the nail, parallel to the lunula (the white crescent shape down the bottom of your nail) — these are sometimes called Mees lines. 

Sometimes patches of white skin, known as leukoderma underneath the nail, can give the impression of partial leukonychia.

There are two types of leukonychia — true or apparent. 

True leukonychia is when the white spot or line is caused by damage to the nail and the white areas remain unaffected even when pressure is put on them. 

In a case of true leukonychia, the areas affected with a white spot or line will eventually grow out with the nail. 

Apparent leukonychia happens when the bed underneath the nail is affected and in turns affects the colour of the plate. 

In this instance, the discolouration will lessen or disappear under pressure but will not grow out with the nail. 

As for what causes it? There are a number of variables dependent on what type of leukonychia you’ve got, including trauma, poisoning and drugs, systemic illness and hereditary causes.

Trauma can occur when injury to the nail plate or area where the nail grows from, known as the matrix, happens. 

Children are most common to suffer this kind of injury, causing white spots. 

However, nail biting, manicures, day-to-day nail injuries and too small footwear are all culprits when it comes to leukonychia growing on your nails.

There are also some forms of poison or medication that can cause those pesky white spots.

While this is relatively rare, it can result in transverse leukonychia (remember that’s when one or more horizontal lines appear across the nail, parallel to the white crescent at the bottom of the nail).

The main poison and medication offenders include: 

• heavy metal poisoning from metals, such as lead and arsenic;
• chemotherapy treatment for cancer; and
• sulphonamides, a medication used for bacterial infections, such as skin infections, septicemia, and infections of the urinary tract. 

Systemic diseases and illness can also cause white nails.

If this occurs, this is a signal there is a problem elsewhere in the body but again, this is rarely the cause of white spots on your nails. 

Illnesses that can lead to white nails include:

• Anemia, which is an iron deficiency caused by a lack of iron in the body; 
• Cirrhosis which is scarring of the liver; 
• kidney disease; 
• heart failure; 
• diabetes; 
• problems with digestion of proteins; 
• an excessive loss of proteins in the intestines; 
• a zinc deficiency; 
• an overactive thyroid; 
• psoriasis; and
• eczema. 

Fungal disease or an infection of the nail or a skin disease around the nail can also contribute to white spots appearing.

While complete regrowth for a fingernail takes between six to nine months; toenails take even longer: 12-18 months.

White spots on nails could be the sign of an injury or condition that occurred or began, several months before.

There are also, in very rare cases, instances where white nails can be blamed on genetics. 

This is usually only because of the presence of rare, complex syndromes including Bart-Pumphrey syndrome (nail problems, knuckle issues, and deafness), Buschkell-Gorlin syndrome (nail problems, skin cysts, kidney stones), Bauer syndrome (nail problems and skin cysts), or Darier disease (wart-like blemishes on various parts of the body).

There are a variety of treatments available but is dependant on the cause of the white spots. 

If your GP can’t put a finger on the cause (see what we did there), there are a number of tests available to help make a diagnosis including: 

• mycology, where fungi and nail clippings are sent away for the study;
• nail biopsy, where a doctor removes a small piece of tissue for testing;
• blood test to identify if there is the presence of a systemic disease

As unbecoming as they may be, there is no treatment for white spots on their own as those that have been caused by trauma will naturally grow out and disappear over time. 

If they are being caused by something other than trauma, a doctor will need to identify the cause and treat it separately as again, treatment is heavily dependent on the case.

But if you or someone you know has any concerns over white spots on their nails, consult a GP.

Are white spots on your nails something that concerns you?