White Spots on Nails (Leukonychia)

What is leukonychia?

Leukonychia is a common condition that causes white spots or streaks on your fingernails or toenails. There are three types of leukonychia:

• True leukonychia: In true leukonychia, the white spots form in the area of your fingers or toes where the nail starts to grow (nail matrix), and appear in the hard part of your nail (nail plate).
• Apparent leukonychia: In apparent leukonychia, the white spots form in the skin on which your nails rest (nail bed).
• Pseudoleukonychia: In pseudoleukonychia, the white spots form on the surface of your nail. Outside organisms — like fungi — cause pseudoleukonychia.

In some people, leukonychia appears as one or two medium-sized spots or many tiny specks. In others, the spots may be very large. You may have spots on only one nail, or you may have spots on many nails.

What do white spots on my nails mean?

White spots usually mean that your nails have experienced some sort of stress. The stress could be from an injury, like hitting your nail against a hard surface, an infection or an allergic reaction. White spots are sometimes the side effects of medications.

What are the most common causes of white spots on nails?

The following are common causes of leukonychia:

• Allergies: Your immune system may interpret products that you use on your nails as allergens and cause white spots to form. These products may include nail polish, nail gloss, nail hardener, nail polish remover and fake nails.
• Injuries (trauma): Injuries to a nail plate or nail matrix are the most common cause of white spots on your nails. You can injure your nail plates or nail matrixes by bumping or hitting your nails, wearing shoes that are too small or biting your nails. Regularly going to a nail salon to get manicures can injure these areas, too. Manicurists may use a lot of force to trim, buff and polish your nails.
• Fungal infections: Fungal infections can make your nails look discolored (sometimes, they might look like they have white spots), thick or cracked.
• Poisoning and medications: White spots may sometimes appear on your nails due to exposure to toxic heavy metals, including arsenic and lead. Chemotherapy and some medications used for bacterial infections and urinary tract infections, including sulfa drugs (sulfonamides), may also cause white spots.
• Systemic diseases: A systemic disease is a disease that affects your entire body. White spots on your nails are sometimes a rare symptom of many systemic diseases, including diabetes, heart failure, HIV, liver cirrhosis and psoriasis.
• Hereditary conditions: Hereditary means inherited — a biological parent passes down something from their genes to their child. Genes determine a person’s physical traits, including hair color, eye color and height. Some hereditary conditions that affect your nails, including Bart-Pumphrey syndrome and Darier disease, may cause white spots to appear.

What deficiency causes white spots on nails?

Healthcare providers and medical researchers aren’t sure whether deficiencies cause white spots to appear on your nails. A deficiency is a shortage of a basic substance in your body that’s essential to your health, like certain vitamins or minerals. Some believe that a lack of minerals — including iron, calcium and zinc — may cause leukonychia. Others think it might be a vitamin deficiency. Still, others believe this isn’t true, or feel there isn’t enough research to make any accurate conclusions.

Does anxiety cause white spots on nails?

Anxiety itself doesn’t cause white spots to develop on your nails. But injury to your nail — like from picking or biting them — might. If you pick at or bite your nails as a result of your anxiety, speak with a healthcare provider.

How are white spots on nails treated?

Treatment for leukonychia depends on its cause. If you have white spots on your nails because of injuries, they’ll slowly grow out until you can remove them with nail clippers or nail scissors. Fingernails grow slowly, and toenails grow even slower. It may take up to six to nine months for white spots on your fingernails to grow out, and it may take 12 to 18 months for white spots on your toenails to grow out.

If you have white spots on your nails but had no injury, a healthcare provider may recommend several tests to help make a diagnosis, including:

• Biopsy: Your healthcare provider uses a razor or surgical knife with a thin blade (scalpel) to scrape away a small sample of cells from your nails. The cells go to a laboratory for testing, and researchers examine them under a microscope.
• Blood test: During a blood test, your healthcare provider will use a thin (21 gauge, slightly smaller than the size of a standard earring) needle to withdraw a small amount of blood from a vein in your arm. The blood sample goes to a laboratory for testing, and researchers examine it to check for the presence of any systemic diseases.
• Potassium hydroxide (KOH) preparation or fungal culture: Your healthcare provider will clip off parts of your affected nails and send the clippings to a laboratory to check for the presence of fungi.

If you have white spots on your nails because of a fungus, your options may include:

• Oral antifungal medication: Your healthcare provider may prescribe liquid medicines or pills or tablets that you swallow with water. These medications may include terbinafine (Lamisil®), itraconazole (Sporanox®) and fluconazole (Diflucan®).
• Topical antifungal medication: Topical medications usually come in the form of creams, ointments or gels. You rub them directly onto your nails.

Nail fungi can be difficult to treat. It’s important to finish your full course of medicine. If you stop too soon, the fungus that causes white spots on your nails may come back and be harder to treat.

If you have white spots on your nails because of an allergic reaction, stop using the product you believe to be the cause.

How can leukonychia be prevented?

The following tips can help prevent white spots from developing on your nails:

• Protect your nails. Use protective gloves when doing activities that may damage your fingernails, including playing sports, working outside or using tools like a hammer. Wear comfortable and protective shoes, and be careful when putting down heavy objects near your feet.
• Moisturize your nails.
• Keep your nails trimmed short.
• Avoid irritating chemicals or products.

When should white spots on nails be treated by a healthcare provider?

Contact a healthcare provider if:

• You develop new symptoms on or around your nails, including nails that easily crack or break (brittle), changes in color, or dents or ridges (Beau’s lines).
• You have white spots on your nails alongside more serious symptoms, including weakness, feeling tired all the time (fatigue), blurred vision, confusion (disorientation) and shortness of breath.
• Your symptoms don’t improve after treatment.

A note from Cleveland Clinic

White spots on your nails often appear after an injury to your nails, like bumping them against a hard surface, hitting them by accident with a tool or biting them. In most cases, your white spots will eventually grow out to the end of your nail until you can clip or cut them off. Though it’s rare, white spots on your nails are sometimes a symptom of a more serious condition. If white spots appear on your nails alongside more severe symptoms, reach out to your healthcare provider.