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Leukonychia in Adult
See also in: Nail and Distal Digit
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Leukonychia in Adult

See also in: Nail and Distal Digit
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Contributors: Shari Lipner MD, PhD, Susan Burgin MD, Bertrand Richert MD, Robert Baran MD
Other Resources UpToDate PubMed

Synopsis

Leukonychia (white nails) occurs in several forms:
  • True leukonychia is characterized by abnormal nail matrix keratinization causing nail plate parakeratosis.
  • Apparent leukonychia is characterized by a white appearance of the nail due to abnormal vasculature of the nail bed.
  • Pseudoleukonychia is white nail caused by exogenous factors.
True leukonychia may be due to either an acquired or an inherited trait. The genetic form is rare and may occur alone or in association with other hereditary conditions such as keratodermas. Other conditions that can be seen with hereditary leukonychia include deafness, accelerated nail growth, and koilonychia.

When acquired, true leukonychia usually appears as one or more transverse white bands running parallel to the distal margin of the lunulae (also called Mees' lines). These lines are often located at the same level on each nail and will move distally and then disappear as the nail grows out. The pathogenesis is thought to be a disruption of nail plate keratinization secondary to systemic stress. This pattern was originally described with arsenic poisoning but has subsequently been associated with chemotherapy, systemic infections (measles, tuberculosis), renal failure, heart failure, and systemic lupus erythematosus. Total leukonychia has been reported in human immunodeficiency virus (HIV)-infected patients. True leukonychia is also seen in patients with Darier disease and Hailey-Hailey disease.

Punctate leukonychia is a pattern of true leukonychia that is usually seen in children and is secondary to trauma. Small white marks grow out with the nail. It can be seen in adults with trauma from manicuring. Apparent leukonychia (Terry nails, half-and-half nails, Muehrcke lines) is often seen with chronic renal failure, nephrotic syndrome, cirrhosis, congestive heart failure, and adult-onset diabetes. Nail bed pallor may be due to anemia, edema, or vascular impairment. 

For more information, see OMIM.

Codes

ICD10CM:
L60.8 – Other nail disorders

SNOMEDCT:
111202002 – Leukonychia

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential diagnosis of white nails includes:
  • Inherited true leukonychia
Acquired true leukonychia (total or partial) due to:
Apparent leukonychia due to:
Pseudoleukonychia due to:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 06/08/2018
Last Updated: 07/06/2018
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Leukonychia in Adult
See also in: Nail and Distal Digit
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Leukonychia : Fingernails, Toenails, White color, Leukonychia
Clinical image of Leukonychia
Apparent leukonychia, showing pallor of some of the fingernails.
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