Leukonychia Explained: What White Spots on Your Nails Could Mean

What is leukonychia?

Leukonychia is a common condition that causes white spots or streaks on your fingernails or toenails. There are three types of leukonychia:

• True leukonychia: In true leukonychia, the white spots form in the area of your fingers or toes where the nail starts to grow (nail matrix), and appear in the hard part of your nail (nail plate).
• Apparent leukonychia: In apparent leukonychia, the white spots form in the skin on which your nails rest (nail bed).
• Pseudoleukonychia: In pseudoleukonychia, the white spots form on the surface of your nail. Outside organisms — like fungi — cause pseudoleukonychia.

In some people, leukonychia appears as one or two medium-sized spots or many tiny specks. In others, the spots may be very large. You may have spots on only one nail, or you may have spots on many nails.

What do white spots on my nails mean?

White spots usually mean that your nails have experienced some sort of stress. The stress could be from an injury, like hitting your nail against a hard surface, an infection or an allergic reaction. White spots are sometimes the side effects of medications.

Possible Causes

What are the most common causes of white spots on nails?

The following are common causes of leukonychia:

• Allergies: Your immune system may interpret products that you use on your nails as allergens and cause white spots to form. These products may include nail polish, nail gloss, nail hardener, nail polish remover and fake nails.
• Injuries (trauma): Injuries to a nail plate or nail matrix are the most common cause of white spots on your nails. You can injure your nail plates or nail matrixes by bumping or hitting your nails, wearing shoes that are too small or biting your nails. Regularly going to a nail salon to get manicures can injure these areas, too. Manicurists may use a lot of force to trim, buff and polish your nails.
• Fungal infections: Fungal infections can make your nails look discolored (sometimes, they might look like they have white spots), thick or cracked.
• Poisoning and medications: White spots may sometimes appear on your nails due to exposure to toxic heavy metals, including arsenic and lead. Chemotherapy and some medications used for bacterial infections and urinary tract infections, including sulfa drugs (sulfonamides), may also cause white spots.
• Systemic diseases: A systemic disease is a disease that affects your entire body. White spots on your nails are sometimes a rare symptom of many systemic diseases, including diabetes, heart failure, HIV, liver cirrhosis and psoriasis.
• Hereditary conditions: Hereditary means inherited — a biological parent passes down something from their genes to their child. Genes determine a person’s physical traits, including hair color, eye color and height. Some hereditary conditions that affect your nails, including Bart-Pumphrey syndrome and Darier disease, may cause white spots to appear.

What deficiency causes white spots on nails?

Healthcare providers and medical researchers aren’t sure whether deficiencies cause white spots to appear on your nails. A deficiency is a shortage of a basic substance in your body that’s essential to your health, like certain vitamins or minerals. Some believe that a lack of minerals — including iron, calcium and zinc — may cause leukonychia. Others think it might be a vitamin deficiency. Still, others believe this isn’t true, or feel there isn’t enough research to make any accurate conclusions.

Does anxiety cause white spots on nails?

Anxiety itself doesn’t cause white spots to develop on your nails. But injury to your nail — like from picking or biting them — might. If you pick at or bite your nails as a result of your anxiety, speak with a healthcare provider.

Care and Treatment

How are white spots on nails treated?

Treatment for leukonychia varies based on the cause. If white spots come from injuries, they will grow out over time. You can remove them with nail clippers or scissors.

Fingernails grow out in six to nine months. Toenails take 12 to 18 months. This is how long it takes for white spots to disappear.

If white spots appear without injury, a doctor may suggest tests. These include:

• Biopsy: A small sample of cells is taken from your nails. It’s tested in a lab.
• Blood test: A small blood sample is taken from your arm. It’s tested for diseases.
• Potassium hydroxide (KOH) preparation or fungal culture: Clippings from your nails are tested for fungi.

If a fungus causes white spots, treatment options include:

• Oral antifungal medication: Pills or liquids are taken to fight the fungus.
• Topical antifungal medication: Creams, ointments, or gels are applied directly to the nails.

Treating nail fungi can be challenging. It’s crucial to complete the full treatment course. Stopping early can make the fungus harder to treat.

If white spots are due to an allergic reaction, stop using the suspected product.

How can leukonychia be prevented?

Here are tips to prevent white spots:

• Protect your nails. Wear gloves for activities that may harm your nails.
• Moisturize your nails.
• Keep your nails trimmed short.
• Avoid irritating chemicals or products.

When To Call the Doctor

When should white spots on nails be treated by a healthcare provider?

See a doctor if:

• You notice new symptoms like brittle nails, color changes, or dents.
• You have white spots with symptoms like weakness, fatigue, blurred vision, confusion, or shortness of breath.
• Your symptoms don’t improve after treatment.