A few spots are common, but widespread whiteness can be serious. (2024)

White spots on the nails or nail bed are known as leukonychia. The most common cause of white spots on the nail is injury, which can be prevented with proper nail care. Other possible causes are allergies to nail products and fungal infections. In rare cases, white spots on your nail can be a sign of a systemic illness or deficiency.

This article covers details about leukonychia, including why white spots on the nails may appear and the causes of white spots on the toes. It also addresses treatment options and when to see a healthcare provider.

Types of White Spots on Nails

Leukonychia can affect part of the nail or the whole nail. When it affects part of the nail, it's called leukonychia partialis. When it affects the whole nail, it's called leukonychia totalis. Leukonychia totalis is often a sign of a serious medical issue like liver failure.

Leukonychia partialis can be further categorized based on its appearance:

• Punctuate: The most common type of leukonychia partialis is punctuate, which is characterized by a few white spots about the size of a pen point.
• Striate or transverse: This describes lines that run parallel to the base of the nail.
  
• Longitudinal: This describes lines that run across the nail toward the fingertip.
  

There are three major types of leukonychia.

True Leukonychia

True leukonychia occurs when the white spots on your nails form at the nail matrix. This is the beginning edge of the nail, located under the skin of your finger just before the visible part of the nail. They appear in the hard part of your nail, called the nail plate.

Apparent Leukonychia

Apparent leukonychia happens when the white spots form on the skin beneath the nail (called the nail bed), rather than on the nail itself. This type can be distinguished from true leukonychia because the spots fade when pressure is applied to the nail, and they do not move across the nail as the nail grows.

Pseudoleukonychia

Pseudoleukonychia is caused by a fungus growing on the outside of the nail. This type causes the upper layers of the nail plate to become scaly.

What Causes White Spots on Nails?

There are many different causes of leukonychia. Some of them are minor issues of normal wear and tear, while others are more serious. The most common causes of white spots on nails include:

Injury

Biting your nails, picking at them, or having a nail bend back due to injury can all leave white marks. Your nails are made of layers of keratin. When injured, these layers can crack or have air trapped between them, leading to white spots.

Allergy

True leukonychia can be caused by irritants or allergens present in nail care products like nail polish and remover, nail glue, or artificial nails.

Fungal Infections

Pseudoleukonychia can happen when fungus grows between the layers of keratin, giving your nails a white appearance. One common infection is onychomycosis, a fungal infection of the toenails.

White spots tied to fungal infections can be treated with antifungal medications.

Serious Illness

White nails, particularly leukonychia totalis, can be a sign of a serious illness or a chronic condition such as:

• Heart disease
• Diabetes
• HIV
• Psoriasis
• Hyperthyroidism
• Hepatitis
• Liver cirrhosis
• Kidney disease
  
• Pneumonia

Vitamin or Mineral Deficiency

White spots on your nails can also result from nutritional deficiencies. Some of these include:

• Selenium
• Zinc

You may have heard that white spots on the nail are caused by a calcium or iron deficiency. This is no longer believed to be true.

Poisoning

Leukonychia may also be a sign that someone has ingested certain poisons, such as arsenic, thallium, or strontium.

Medication

Sometimes, people undergoing chemotherapy will develop white spots on their nails. Most often, chemo causes leukonychia striata, lines that run parallel to the base of the nail. Retinoids, certain opioids, sulfa drugs (a type of antimicrobial), and medications that prevent organ rejection can also cause this.

Genetics

Many different inherited conditions can cause leukonychia. Some of these include:

• Bart-Pumphrey syndrome
• Carvajal/Naxos syndrome
• Keratosis follicularis
• Lowry-Wood syndrome
• FLOTCH (Bauer) syndrome
• Buschkell-Gorlinsyndrome
  

Diagnosing White Spots on Nails

Having white spots on your nail may seem like a minor condition. If you have an occasional white spot tied to a specific injury like picking your nails or slamming your finger, you likely don’t need to see a healthcare provider.

However, you should speak with a healthcare provider if you have frequent or widespread leukonychia or lines running through your nails. White spots or nail color changes can seem harmless, but they might also be a sign of a severe or worsening health condition, like liver disease or diabetes.

It’s important that your healthcare provider is aware of these changes so that they can address the underlying cause of the white spots.They can consider possible diagnoses depending on the type and classification of the white spots on your nails.

Dermoscopy can help your healthcare provider see abnormalities that may not be visible to the eye. In cases that aren't easily identified as trauma, they may want to take a clipping (mycology), do a nail biopsy, or order a blood test.

When they begin treating the underlying health condition, you’ll likely notice that the white spots on your nails improve.

Summary

White spots on the nails most often result from a small injury, like biting your nails or jamming your fingertips. These injuries can cause air to get trapped within the nail, giving it a white appearance. Fungal infections within the nail can also cause white spots.

In some cases, white spots on the nail are a sign of serious illness, like diabetes, liver disease, or kidney disease. If you have many white spots on your nails, it’s best to see a healthcare provider for evaluation. They can help you identify what might have caused the spots and treat the underlying health condition.