What causes white spots on nails?

The medical term for white spots on nails is leukonychia. Developing these white spots is not typically alarming or a sign of a health condition. In fact, most people will notice leukonychia on their nails throughout their lives.

Leukonychia may appear in different ways on your nails, including:

• as small white spots (punctate leukonychia)
• as a white band (longitudinal leukonychia)
• as one or multiple horizontal lines parallel to your lunula (transverse or striate leukonychia)

This article will review the different causes of white spots on your nails, how doctors reach a diagnosis, how to treat the white spots, and how you may prevent their formation.

Causes of white nail spots

In most cases, white nail spots on your nails are due to trauma, according to 2022 research.

An injury to the tips of your fingers may damage the nail matrix, which produces the nail itself. Sometimes, it can take up to 4 weeks after the injury to notice white spots on your nails. This is because it takes time for nails to grow.

However, other factors may also cause white nail spots.

Allergic reaction

If you have an allergy to certain cosmetic products, such as nail polish remover or nail glue, you may develop white spots on your nails. This is because these products contain chemicals that may damage your nail.

Systemic health condition

White spots on your nails may be a sign of an underlying medical condition, including:

• heart disease
• chronic anemia
• diabetes
• liver cirrhosis
• hyperthyroidism
• kidney failure

You should consider contacting your doctor if you have many unexplained white spots on your nails that do not go away.

Mineral deficiency

In some cases, white spots on your nails mean you have mineral and vitamin deficiencies, including zinc. A doctor can help diagnose whether you have any deficiencies.

Hereditary white spots

Sometimes, leukonychia is due to a genetic condition called leukonychia totalis. People with this condition typically have whitening of the entire nail plate, and it usually involves all the nails.

Leukonychia totalis is also known as total leukonychia. This condition is extremely rare, and it is usually linked to other systemic health conditions.

Injury to the nail from cosmetic procedures

Using nail cosmetics, like nail glue or nail polish, may cause nail fragility, a 2020 research review suggests. This may appear as white spots on your nails.

Applying artificial nails may also cause nail damage from dehydration and keratin disruption.

Poisoning and adverse effects of medications

People may develop whitening of their nails due to heavy metal poisoning or after undergoing certain medical treatments. These may include:

• arsenic poisoning
• lead poisoning
• chemotherapy
• the use of synthetic antimicrobial drugs for bacterial infections, like sulfonamides

Skin conditions

Skin conditions, like atopic dermatitis, may induce changes in the nail matrix. This may cause nail dystrophy and the appearance of atypical spots on your nails.

People with nail psoriasis may also notice a change in the appearance of their nails. Nail psoriasis may cause changes in the shape and color of the nails.

Fungal infection

Fungal infections may affect the health of the nail. When fungi infect your nail, you may develop some white spots. These spots may differ depending on the type of fungal infection.

Conditions like mycosis fungoides may cause nail thickening and scaling, per a case study from 2021 and another small study from 2018. The nail may also experience weakness (fragility) and breakdown (dystrophy).

Diagnosis

A physical examination and your medical history are usually sufficient for a doctor to diagnose the causes of your white spots. However, in certain cases, your doctor may suggest additional tests, including:

• nail clipping to test for fungal infection
• nail biopsy for laboratory tests
• tests for mineral and vitamin deficiencies

They may also suggest blood tests to evaluate if you have a systemic disease, including:

• renal and liver function
• the presence of an underlying systemic disease
• liver function
• renal function
• heavy metals poisoning

What are the treatment options?

If a trauma causes white spots on your nails, it does not typically need any treatment. The nail will grow, and you will eventually be able to cut the part of the nail with the spot.

However, if the cause of your white spots is not trauma, a healthcare professional will need to identify the underlying cause and can recommend a suitable treatment.

This may involve:

• stopping the use of harsh chemicals on your nails
• using antifungal preparations
• eliminating products that you are allergic to on your nails
• treating any skin conditions causing the white spots

A doctor can help you address the cause of white spots on your nails. They can also recommend the most appropriate treatment for the condition.

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Preventing white spots on your nails

In some cases, you may not be able to prevent white spots from appearing on your nails. However, there are some precautions that may help you reduce their occurrence.

These may include:

• taking note of when the spots appear and whether using specific products triggers them
• avoiding the use of harsh chemicals on your nails
• talking with a doctor if white spots come, go away, and return (recurrent)
• protecting your nails from trauma and strengthening them
• eating a balanced diet to reduce the risk of vitamin and mineral deficiencies

Summary

White spots on nails are typically not a cause for concern, and most people will experience them throughout their lives. The white spots usually go away on their own without treatment. However, they may sometimes be a sign of underlying conditions that may need medical attention.

You may consider contacting your doctor if you notice new and recurring white spots on your nails. They can diagnose their cause and recommend the most appropriate treatment.

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