Nobody’s nails are perfect. They break easily, they’re brittle, they peel…all of these are common. But white spots on your nails are a bit less common because the reasons for white spots on nails, a condition known as leukonychia, are a bit more specific.
“Leukonychia is a condition where people get these white dots or lines on their fingernails,” said Karan Lal, D.O., a double board-certified dermatologist with Affiliated Dermatology in Scottsdale, Ariz. “The most common cause of this is trauma, but it can also be associated with various medical conditions.”
Meet the experts: Karan Lal, D.O., M.S., F.A.A.D., double board-certified dermatologist with Affiliated Dermatology in Scottsdale, Ariz.; Brendan Camp, M.D., a double board-certified dermatologist in dermatology and dermatopathology at MDCS Dermatology
There are a few main types of leukonychia. Apparent leukonychia is when white spots appear on the nail bed under your nail and disappear when you put pressure on the nail, explained Brendan Camp, M.D., a double board-certified dermatologist at MDCS Dermatology. There’s true leukonychia, in which the white spots originate from the nail matrix (where your nail grows) and appear on the nail plate, said Dr. Lal. These spots do not disappear with pressure. Then there’s pseudoleukonychia, in which white spots appear as flaking on top of the nail and are most often caused by fungi, said Dr. Lal.
Here, dermatologists explain where these spots come from, along with how a doctor will diagnose them and the most common treatments for getting rid of them.
Common causes of white spots on nails
The presence of white spots on your nails can mean a number of things. Experts say the discoloration is most commonly due to injury and is usually not a major cause for concern. However, certain conditions may be associated with white spots or lines on the nail. These are the ones you need to know.
Fungal infection
“Some fungal infections can cause a white discoloration of the nail plate as opposed to the more traditional yellow color associated with fungal infections,” explained Dr. Camp. A specific type of fungal infection called superficial white onychomycosis is one that Dr. Lal said he often sees, which is characterized by “white flaking on the top of the fingernail.”
Psoriasis
Dr. Lal said that psoriasis (an autoimmune condition affecting the skin) can cause leukonychia. It can also cause something called onycholysis, “which is when the nail plate separates from the nail bed and causes the formation of white spots,” said Dr. Camp.
Trauma
Trauma to the nail from some type of injury can lead to white discoloration, explained Dr. Camp. This can be from hitting your nail on a hard surface, getting your nail caught on something, or biting your nails. Dr. Camp also noted that manicures and pedicures may cause white spots on nails due to the tools, polishes, and chemicals used during the service.
Medications
Certain medications have the potential to cause white spots on your nails as well. Dr. Lal said the most common medications that can do this are chemotherapy drugs and long-term antibiotics such as sulfonamides.
Underlying medical conditions
“There are other forms of leukonychia that can be associated with internal conditions, such as liver disease, kidney disease, and even heart failure,” Dr. Lal explained. For example, “half and half nails,” in which half the nail (horizontally) is entirely white, may be an indicator of kidney disease, Dr. Lal said. He also pointed to Muehrcke lines, which are characterized by transverse or longitudinal white lines that run across the nail and may mean a deficiency in albumin protein.
“When things look more uniform…those are concerning signs in terms of a possible medical condition,” Dr. Lal said. In other words, if you have similar spots on all your nails, it may be cause for concern. Other skin conditions like alopecia areata, lichen planus, and atopic dermatitis can also cause white spots on the nails, Dr. Camp added.
Tests to diagnose the cause of your white spots
If you visit the dermatologist about white spots on your nails, there are a few different tests and evaluations they may try.
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Nail scraping
Your doctor may scrape your nails to rule out a superficial fungal infection, which Dr. Lal said is “quick, effective, and easy” to perform in the office.
Nail biopsy
“Very rarely, we will do a nail biopsy, but that’s not very common,” said Dr. Lal. To perform a biopsy, your doctor would use a scalpel to gather skin cells from your nails and send them to a laboratory for testing.
Full physical exam
Dr. Lal said that the main thing to consider when it comes to the nails is potential underlying causes. The best way to determine what these may be is to conduct a full physical exam, which involves your doctor looking at your fingers and toes and potentially ordering a comprehensive blood panel.
How to get rid of white spots on nails
Once you’ve determined what’s causing the white spots on your nails, you can take steps to get rid of them. Here are the treatments you can expect based on the reason for your white spots.
Nail protection
“Trauma-related leukonychia will usually grow out with the nail plate over time,” said Dr. Camp. While you allow these white spots to diminish, protect your nails from further trauma by keeping them trimmed short (to avoid bumping and snagging), and try not to over-file or buff your nails. “Anything that’s going to damage the nail plate could theoretically cause leukonychia,” said Dr. Lal. “Try not to tap your nails often, don’t pick at your nails, and don’t bite at your nails.” You can also try using nail strengtheners and cuticle oil to keep your nails strong and healthy.
Antifungal medications
If your doctor determines that you have a fungal infection causing the white spots, they prescribe an antifungal treatment (if over-the-counter options do not work), explained Dr. Camp.
Systemic therapy
For certain conditions like psoriasis, systemic therapy is often needed as “psoriatic nails are difficult to treat with topicals,” said Dr. Camp. The type of psoriasis treatment (likely a medication) your dermatologist selects for you will depend on your unique symptoms, lifestyle factors, and other medical conditions or medications.
When to call your doctor for white spots on your nails
If you’re worried, it’s always best to consult your physician. “White spots can be an indication of underlying medical disorders or infection. If they do not grow out with the nail and disappear or do not respond to over-the-counter treatment, see a board-certified dermatologist for evaluation,” said Dr. Camp
Additionally, if you notice any other symptoms such as swelling, changes in color, or a uniform appearance of white spots on your nails, Dr. Lal encouraged you to see your dermatologist. They can help you get to the bottom of things and initiate the treatment you need.
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