Dana Stern, MD
Dana Stern, MD, is a board-certified dermatologist practicing in New York City and Southampton, assistant clinical professor of dermatology at Mount Sinai Medical Center and founder of nail care company Dr. Dana. DrDanaNails.com
Startled to see white spots on your nails? Most of the time, they will simply grow out, but you might need to show your fingers some TLC to prevent them from recurring. Bottom Line Personal asked board-certified dermatologist Dana Stern, MD, what those spots mean…where they come from…and how to get rid of them…
By and large, white spots on nails are caused by trauma to the nail, such as from whacking your finger by mistake with a heavy can or against a countertop corner. They also can happen to toes—typically from wearing shoes that are too tight—but you may be less likely to notice them. Called punctate leukonychia (“punctate” meaning small, dotlike white spots, and “leukonychia” meaning white nails), this is temporary damage to the matrix, where the base of the nail tucks under the skin. White spots formed this way usually are harmless. They’re also more common in children who are prone to mishaps and whose thinner nail plates (what people refer to as their fingernails) offer less protection to the matrix.
Other sources of nail trauma: Biting your nails and repeated harsh manicures.
Another type of white discoloration: More than just drying out nails, the chemicals in certain nail products can cause keratin granulations that look like chalky white patches. Keratin granulations can happen from wearing nail polish for a prolonged period of time (common on toenails) and not using a base coat under the polish. Giving nails a break from polish and other chemicals will help nails heal. Sometimes the discoloration fades, but other times it will need to grow out.
These spots will simply grow out as your matrix generates keratin, the protein building block of nails. Since fingernails tend to grow at the slow pace of three millimeters a month, it can take six or more months for the spots to grow out—and there’s really nothing you can do to speed up the process.
Many white nails, or leukonychia, are due to something going on in the nail bed as opposed to the nail plate. When a medical condition impacts the nail bed, it doesn’t typically present as white spots or patches but more as diffuse lightening of the nail that worsens when you apply pressure. Examples of this phenomenon: Terry’s nail, in which about two-thirds of the nail turns white…and Lindsay’s nails, with about half the nail turning white.
Terry’s nails can be a symptom of serious health concerns such as liver disease, congestive heart failure and diabetes. Lindsay’s nails are primarily linked to kidney disease such as chronic renal failure. In general, any sudden change to more than one nail should be evaluated by a dermatologist with a thorough history and exam and appropriate testing.
What white spots aren’t: White spots are only very rarely caused by vitamin deficiency, and they typically are not a sign of an allergic reaction, which is more likely to affect the skin around the nails, or a medication side effect. Certain medications, including some NSAIDs, doxycycline (used to treat bacterial infections) and chemo drugs, may cause the nail to lift and separate from the nail bed, a condition called onycholysis.
Accidents affecting your hands can’t always be avoided, but there are care steps you can take to protect your nails…
