White nails also known as albinism, is the partial or complete discoloration of the nail plate of one or more fingernails or toenails.
White nails are the most common nail discoloration. The nails lose their pink tint and appear white.
How Are White Nails Classified?
It can be classified according to the underlying pathology, its distribution, or development.
Pathological classification
White nails can be divided into true and apparent discolorations.
- True white nails: discoloration due to abnormal keratinization of the nail plate, white nails are not hidden by the pressure of the plate on the nail bed.
- Apparent white nails: This is a result of nail bed disease, this appearance disappears when pressure is exerted on the nail
White nails classification by development
It can be acquired or congenital.
- Congenital: Familial albinism is often inherited in a recessive manner, although a dominant pattern is also possible. This is due to a mutation in the phospholipase C delta 1 gene, which causes all nails to have a milky, porcelain-white appearance.
- Acquired: Occurs due to systemic disease, also note that congenital white nails can also occur due to systemic disease.
Who gets a white nail?
It can affect anyone regardless of age, gender, or ethnicity, its presence may warrant assessment of systemic disease.
Causes of white nails
These are various causes of white nails:
Partial or complete damage to the nail plate, or nail matrix. Destruction of keratin by air trapped in the nail plate will result in a form of reflection or transparency. When one bites one’s nail, application of nail polish, wearing of tight shoes, damage to the nail matrix, can also occur after severe damage which can result in the detachment of the nail plate from the nail sheet.
Types of white nails that can be associated with systemic diseases
There are majors three types of white nail with underlying medical conditions:
- Muehrcke’s line: A pair of visible and nonpalpable horizontal white lines across the nail caused by fluctuations in blood flow.
- Lindsay nail ( half nail): White or pink proximal nail with distal darkening
- Terry nails: most of the nail is lightened with a fine darkening of 0.5 to 3.0 mm at the tips.
Systemic disease
Terry’s nails are related to cirrhosis of the liver, chronic kidney disease, heart failure, diabetes, protein-losing enteropathy, iron deficiency, zinc deficiency, and hyperthyroidism.
Lindsay’s nails are associated with chronic kidney disease and psoriasis.
Muehrcke’s line is associated with hypoalbuminemia
Chronic features of white nails
Partially disseminated leukoplakia, punctate leukoplakia ( the most common forms of leukoplakia known as the small white dots on the nail) are usually the result of trauma, and only a few nails are often affected.
Vertical vitiligo: small white vertical stripes, it occurs in people with Darier’s disease or Hailey Hailey’s disease
Streaks or transverse vitiligo ( Mees lines): Where there are one or more horizontal stripes on the nail that runs parallel to the nail moon.
Patients with multiple forms of white nails require a detailed history, physical examination, and medical review to rule out toxic or systemic causes. This also is applicable to vitiligo which spreads over the entire width of the nail plate.
Careful examination of one’s nail coloration is essential, this can be an important medical indicator to varieties of undetected underlying medical conditions in a person.
Nail hygiene should also be encouraged, just like every other part of our body system that needs proper hygienic care, our nails are also important in this regard.
It is when nails are given proper attention that some of these coloration changes can easily be noticed, hence it will help to give proactive attention that is needed medically.
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