Why You Might Have White Spots on Your Nails

White spots on fingernails or toenails are usually not a sign of anything serious. There are many reasons you can develop white spots, medically known as leukonychia. The discoloration can be caused by injury to the nail, habits like nail biting, or certain vitamin deficiencies.

Sometimes the white discoloration can look like streaks or take up the entire nail. More so in these cases, leukonychia could potentially be a sign of a condition that might need treatment, like diabetes.

Unfortunately, there isn’t a quick way to get rid of the white spots on your nails. Leukonychia resolves with healthy nail regrowth, which can take weeks or months. Treating underlying causes can also help resolve the condition. There are several steps you can take to even prevent the white spots on your nails.  

What Are the White Spots on Your Nails?

White spots on your nails are known as leukonychia.

There are actually several types of leukonychia, and the types are categorized based on what shape the white discoloration is. White spots that are separate, small, and circular are called leukonychia punctata. They're the most common form of leukonychia.

White discoloration may also appear as lines or larger spots. The whole nail might even turn white. Each pattern is a different type of leukonychia:

• Transverse leukonychia: Also known as Mees’ lines, these are streaks or lines of white moving across the nails. Named after the physician who first identified them, the lines are about 1 to 2 millimeters in width.
• Longitudinal leukonychia: This is the development of lines moving down the length of the nail. Certain skin conditions, such as Darier’s disease, cause these lines as well as patches or lines of red, leading to what are called candy cane nails.  
• Partial leukonychia: This is when the white forms dots that takes up a significant portion of the nail—often half or more.
• Total leukonychia: Also known as leukonychia totalis, this is when there is a chalky or milky whitening of the entire nail.

What Causes White Spots on Nails?

There are layers of supportive tissues beneath the hard outer shell, or nail plate. Leukonychia is categorized as "true" or "apparent" based on whether it's the nail or the tissue underneath causing the discoloration.

True leukonychia means there is damage to the nail. Specifically, there would be a problem within the nail plate's matrix (the area where cells for new nails are created). White spots, or leukonychia punctata, are considered true leukonychia.

Apparent leukonychia is caused by disorders of the nail bed, the tissue underneath the nail.

Although they might be alarming, in most cases, white spots on a finger or toenail usually aren’t a sign of a serious issue. However, leukonychia has many causes, and sometimes it’s a symptom of a condition that might need treatment.

Nail Damage

Hitting your thumb with a hammer or getting your finger closed in a door can cause white spots on your nail. So can picking or biting your nails. Minor injuries or traumas are the most common reasons for white spots on the nails.

Another common cause of nail damage—and the related leukonychia—is the use of nail polish, glue, or acrylic nails. White spots on your nails can develop as an allergic reaction to these products. This kind of damage can also be caused by manicures that are too thorough or other cosmetic procedures.

Nail Fungus

Fungal infection of the nail bed is another common cause of white spots. Onychomycosis is a fungal infection affecting toenails that can cause leukonychia in the infection's early stages. If allowed to advance, the fungus spreads and turns the nail brittle, or a yellow or brown color.

Mineral Deficiency

Not getting enough of certain minerals in your diet can bring on leukonychia. The small spots of leukonychia punctata have been linked to zinc deficiency. In addition, calcium, selenium, and iron deficiencies can all cause the white discoloration.

Health Conditions

White spots on the nails can be caused by inflammatory conditions like psoriasis, an autoimmune disease that causes itchiness and dryness, or alopecia, the development of bald patches.

Other types of leukonychia may develop from other conditions. For instance, lichen planus, an itchy rash causing purple welts on the skin, can cause vertical white lines on your nails.

Other conditions that can cause leukonychia—mainly in the form of vertical or horizontal lines—include diabetes, pneumonia, hepatitis, and hyperthyroidism.

Medication

Certain medications and treatments can prompt white spots or lines on your nails. Transverse and longitudinal leukonychia are common side effects of cancer treatment. This includes therapy with chemotherapy drugs like Hydrea (hydroxyurea), Zolinza (vorinzostat), and Bicnu (carmustine).

Other medications that can cause white discoloration of your nails include:

• Retinoids, medications derived from vitamin A, including Soriatane (acitretin)
• Neoral (cyclosporine), an immunosuppressant drug
• Trazodone D (trazodone), an antidepressant
• Certain antibiotics, such as Sulfazine (sulfamide) and Bactrim (sulfamethaxazole)
  

Hereditary Causes

It is rare for leukonychia to be inherited. When inherited, the discoloration would typically affect the entire nail. Conditions that can cause leukonychia to be passed down from parent to child include congenital hyperparathyroidism (an overactive parathyroid gland) and Bart-Pumphrey syndrome, which causes hearing loss and abnormal knuckle pads.

Poisoning

Having high levels of heavy metals, such as strontium and thallium, can also cause transverse leukonychia. Arsenic poisoning can also cause this issue. Causing a range of symptoms, such as abdominal pain, chills, hot flashes, vomiting, and nausea, it’s important to get emergency help if you suspect you have heavy metal toxicity or any other kind of poisoning.

When To See a Healthcare Provider

If the white spots on your nails are the result of an injury, you probably won’t need to see a healthcare provider. If you notice that the spots come back, consider seeing a healthcare provider. While many cases are harmless, leukonychia can be a sign of a health condition, like a fungal infection or mineral deficiency, that may need treatment.

If your nail has white lines or larger areas of white, you may also want to consider getting your nails evaluated since these types of leukonychia may be associated with other health conditions that may need treatment, such as diabetes.

Diagnosis typically involves physical evaluation, assessment of your medical history, as well as tests for any underlying conditions. The blood tests may be to check liver or kidney function or to detect other diseases. Sometimes, dermoscopy—magnified photographs of the affected nails—can help providers track the progress of the condition.

How To Get Rid of White Spots on Nails

Treatments for leukonychia depend on the underlying cause of the condition. There are several major treatment strategies:

• Watching and waiting: If your white spots are due to finger trauma, as in biting your finger, healthy nail will regrow. Over time, you’ll be able to clip off the white spots with nail trimmers. Note that healthy nail growth can take a while. Fingernails grow about 3 millimeters (mm) a month, and toenails growing about 1 mm in the same time span.
• Anti-fungal therapy: Cases linked to nail fungus are treated with prescribed antifungal creams and medications. Severe cases may require surgical nail removal and regrowth.
• Medical treatment: If you have severe or recurring white lines or partial or total leukonychia, you’ll likely need additional testing to detect the condition causing the issue. Treating the underlying cause of the leukonychia should resolve the condition.
• Covering up: If it’s safe for you to do so, you can consider using nail polish to cover up affected areas. While this improves appearance, it doesn't treat the white spots directly.

How To Prevent White Spots on Nails

If your leukonychia is recurrent or happens frequently, there are several steps you can take to protect your nails. These include:

• Limiting or stopping the use of nail polish, nail glue, acrylic nails, and other damaging products
• Keeping your fingers safe from injury, such as by wearing protective gloves
• Stopping nail biting, picking, or other damaging habits
• Taking zinc, calcium, selenium, and iron supplements to prevent mineral deficiency
• Taking a biotin (B7) vitamin daily to strengthen nails
• Using clear nail polish that has protein to strengthen nails
• Ensuring footwear is comfortable and leaves enough room for your toes
• Clipping nails straight across and removing hangnails
• Moisturizing the nails with emollient cream after bathing

A Quick Review

White discoloration of the nail is known as leukonychia. There are different types of leukonychia. The type that is characterized by white spots is called leukonychia punctata. This is the most common form of leukonychia and is typically caused by injury from nail biting or picking. Other forms of leukonychia bring on different patterns of white discoloration, like lines and larger patches of white. More so in these cases, the white discoloration can be a sign of an underlying condition that might need to be treated. If injury is causing leukonychia, no treatment is likely needed. The white part will grow with the nail and can be clipped off when grown out. Other causes of leukonychia might need treatment. Protecting your nails from injury or stopping nail biting can prevent white spots from cropping up in the future.