Congenital andor hereditary Isolated

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Acrokeratosis verruciformis (Hopf) Associated with koilonychia (Figure 7.8)

LEOPARD syndrome (lentigines, electrocardiographic changes, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, deafness)

Associated with deafness

Leukonychia totalis, multiple sebaceous cysts, renal calculi Darier's disease—usually linear and longitudinal Acquired Pseudoleukonychia

Diffuse form of distal and lateral subungual onychomycosis Proximal white subungual onychomycosis, especially in AIDS patients Superficial white onychomycosis

Keratin granulation (superficial friability from nail varnish) Psoriasis

Apparent leukonychia (Figure 7.9) Anaemia

Cancer chemotherapeutic agents Cirrhosis (Terry's sign) Dyshidrosis

Half-and-half nail (renal diseases) and distal crescent pigmentation Leprosy

Muehrcke's lines of hypoalbuminaemia True leukonychia Alkaline metabolic disease Alopecia areata

Carcinoid tumours of the bronchus Cardiac insufficiency

Cytotoxic and other drugs (emetine, pilocarpine, sulphonamide, cortisone) Erythema multiforme Exfoliative dermatitis

Fasting periods (e.g. in orthodox Jews and Muslims)



Hodgkin's disease Hypocalcaemia

Infectious diseases and infectious fevers Intra-abdominal malignancies Kidney transplant Leprosy

Leuko-onycholysis paradentotica

Menstrual cycle

Myocardial infarction



Peripheral neuropathy

Poisoning (antimony, arsenic, fluoride, lead, thallium)

Protein deficiency


Psychotic episodes (acute) Renal failure (acute or chronic) Shock

Sickle cell anaemia Surgery

Sympathetic leukonychia

Trauma (single or repeated)

Tumours (benign), cysts pressing on matrix

Ulcerative colitis

Zinc deficiency

Leukonychia may also occur in other dermatoses affecting the matrix, such as alopecia areata, dyshidrosis, Darier's disease and Hailey-Hailey disease (Figure 7.7). Table 7.1 lists many of the causes and factors leading to leukonychia.

Hailey Hailey Disease Pictures

Figure 7.8

Leukokoilonychia. (Courtesy of A. Puissant, Paris.)

Figure 7.8

Leukokoilonychia. (Courtesy of A. Puissant, Paris.)

Leukonychia Trichophytica

Figure 7.9

Apparent leukonychia in Raynaud's syndrome.

Figure 7.9

Apparent leukonychia in Raynaud's syndrome.


Exogenous white stains and particularly superficial white onychomycosis (Jessner's leukonychia trichophytica) cause white nails. In temperate climates the cause of superficial white onychomycosis is usually Trichophyton mentagrophytes, but in hot and humid climates also moulds such as Fusarium species may infect the surface of the nail plate. The nail is white and opaque also in proximal subungual onychomycosis and endonyx onychomycosis. Long-term application of nail varnish, layer over layer without prior removal of previous lacquer, may cause a peculiar softening and white colour of the nail surface (Table 7.1).


Colour change to brown or black (Figures 7.10-7.16) is potentially serious because malignant melanoma (see Chapter 5) may present in many guises; however, many less

Table 7.2 Causes of melanonychia_

Black nails Naevi (Figure 7.10) Racial (Figure 7.11)

Drugs, e.g. doxorubicin, cyclophosphamide Haemorrhage (Figure 7.12) (see Chapter 9) Malignant melanoma (see Chapter 5)

Onychomycoses (Trichophyton rubrum var. nigricans, dematiaceous fungi) Silver nitrate Brown nails Exogenous

Drugs and dyes, e.g. dithranol, potassium permanganate (Figures 7.13-7.16) Endogenous Naevi, lentigines

Laugier-Hunziker-Baran syndrome (see Chapter 5) Peutz-Jeghers-Touraine syndrome Racial (black, Asian) Addison's disease

Drugs, e.g. chlorpromazine, tetracyclines, ketoconazole, sulphonamides, cytotoxics, acyclovir

Fetal hydantoin syndrome



Nail enamels and hardeners


Thyroid disease

Smoking, tar_

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    How to cure leukonychia spots?
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