White spots on nails: Should you be worried?

Your skin, nails, and hair speak volumes about your overall health. Pink and glossy nails are not only pleasing to the eye but also announce you're in good health. But what if you have white spots on your nails? Does that mean something is amiss? Let's find out!

Leukonychia or white discoloration on your nails is usually harmless. They are usually a result of an injury in the nail due to biting, excessive tapping, or some other trauma. Most white spots tend to heal on their own and disappear once the nail has grown out fully, which is in about 6-8 months. But in some cases, it could signal serious underlying issues like kidney, liver, or heart problems. That's reason enough to be wary.

Types of Leukonychia

Leukonychia usually takes on two main forms:

• Total leukonychia is usually inherited and involves whitening of the whole nail.
• Partial leukonychia, as the name suggests, indicates partial whitening of the nail plate. The three variations of partial leukonychia are leukonychia striata, leukonychia punctata, and longitudinal leukonychia.
• Also known as Mees' lines, leukonychia striata or transverse leukonychia appears as white bands that run parallel to the nail base.
• Leukonychia punctata shows up as small white spots on the nail and is considered "true" leukonychia.
• Longitudinal leukonychia is rare and involves tiny longitudinal white lines under the nail plate.

Another variation of leukonychia is pseudoleukonychia. But unlike the other forms, this white discoloration is caused by changes in the nail bed rather than the nail plate. Half and half nails, Terry's nails, and Muehrcke's nails are three types of pseudoleukonychia.

What causes white spots?

Air bubbles, trauma, or injury

More often than not, there may be no major underlying reason for leukonychia. It could simply be a case of air bubbles trapped inside the keratin layers of the nails. This can result in opacity and cause the spot-like appearance. These tiny air bubbles are mostly the result of some kind of trauma to the nail - for instance, when you stub a finger.

Transverse leukonychia is frequently observed after a bad manicure. If seen in toenails, it could be because of trauma from wearing tight shoes.

Zinc or Albumin deficiency

Contrary to popular belief, leukonychia is not caused by calcium deficiency. However, zinc deficiency or albumin deficiencies are known to cause the spots. Zinc plays an important role in many enzyme systems in our body and zinc deficiency can have many adverse effects on the body. Leukonychia can be one such effect and it usually responds to zinc therapy.

Low serum albumin levels indicate low levels of protein in the blood and the condition causes Muehrcke's nails, a form of pseudoleukonychia.

When should you worry?

Occasional white spots on one or two of your nails aren't a cause for worry. But if you're seeing spots, streaks, or discoloration in all of your fingers and you've had them for a while, it's time to make an appointment with your doctor. If an underlying medical condition is to blame, other symptoms may also make an appearance.

• White nails: If the nails get dotted with white spots or the entire nail turns white, the condition is called white nails. Typhoid, leprosy, and nail biting are often linked to this condition.
• White or discoloured nail bands: Parallel discoloured lines on the nails could be associated with heavy metal poisoning like arsenic poisoning. They can be a sign of carbon monoxide poisoning, too. This is also found in people with renal failure and those undergoing chemotherapy. White nail bands like Mees' lines also appear with some infectious diseases, especially those accompanied by a high fever. These include illnesses as diverse as malaria, measles, leprosy, herpes zoster, and acute respiratory infections.
• Half and half nails: In this condition, an individual's nails may be part white and part brown. Almost 40% of patients with kidney failure have half and half nails. This is often seen in dialysis patients and sometimes after chemotherapy. Psoriasis and AIDS are two other diverse conditions where half and half nails have been observed.
• Terry's nails: In this case, nails become multicolored with pink or brown tips. Fungal nail infections may be to blame here. Sometimes, it can be a result of reduced blood supply to the nail bed. And that could be an indication of renal failure, type 2 diabetes, anemia, thyroid issues, heart problems, chemotherapy, liver problems, and even malnutrition. About 80% of individuals who have liver cirrhosis have Terry's nails.
• Muehrcke's lines: These appear as whitish bands parallel to the nail base. Since the bands are on the nail bed, they do not disappear with nail growth. Liver disease, malnutrition, and albumin deficiency are known to cause this condition. Swelling in the nail plate, which presses down on the underlying blood vessels, can also be a trigger.

Taking care of your nails

• If nail injury is the cause of your white spots, there's no need to worry. The spots should disappear in about 8 months. That is the approximate time it takes for your nails to fully grow out.
• If the white spots are a result of dietary deficiencies, you're likely to see the condition recurring. A few tweaks in your diet and daily habits will take care of this minor problem. Have foods rich in zinc such as oysters, beef, fortified breakfast cereals, baked beans, chicken, yogurt, cheese, low-fat milk, almonds, and kidney beans. Eat healthy and increase your protein intake to overcome protein deficiency. Get in seafood, poultry, eggs, beans, and dairy products such as milk, cheese, and yogurt.
• Look after your nails! Keep them clipped, wear gloves for any heavy-duty work, and stay away from excessive nail cosmetics to avoid injury or damage to your nails. Go easy on the pedicures and manicures - when overdone; they do more harm than good to your nails.
• Protect your toenails. Wear shoes that fit well without squeezing your toes.
• Consider meditation to calm your nerves. It might stop you from tapping persistently or biting your nails. Get help from a therapist if needed.
• And finally, do not panic and self-diagnose one of the conditions you've just read about. Remember, white spots often appear several weeks after an injury. So you may have well forgotten about the injury that could've caused them.

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