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Abstract
Changes in nail color can provide important clues of underlying systemic and skin disease. In particular, white discoloration (leukonychia) has a high prevalence with a wide array of potential relevant causes, from simple manicure habits to life-threatening liver or kidney failure. Therefore, a reliable assessment of the patient with leukonychia is essential. In the past, two classifications for leukonychia have been presented. The morphological classifies the nail according to the distribution of the white lines: total, partial, transversal, and longitudinal leukonychia. Mees’ and Muehrcke’s lines are examples of transversal leukonychia, while Terry’s and Lindsay’s nails are examples of total and partial leukonychia. The anatomical classifies according to the structure responsible for the white color: the nail plate in true leukonychia, the nail bed in apparent leukonychia, and the surface only in pseudoleukonychia. In this review, both morphological and anatomical features have been combined in an algorithm that enables clinicians to approach leukonychia efficiently and effectively.
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2
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Freeman SC, Dick MK, Abid R, Tabatabai TM, Berrebi KG, Stone MS, Powers JG. A case of idiopathic acquired leukonychia totalis in a 17-year-old boy. Pediatr Dermatol 2021; 38:477-480. [PMID: 33534174 DOI: 10.1111/pde.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Whitening of the nail, or leukonychia, can have a wide range of etiologies including genetic disorders, trauma, poisoning, autoimmune disorders, and infections. Here we detail a case of idiopathic acquired leukonychia totalis in a 17-year-old boy. This condition has been reported 13 times in the literature previously, with only young boys being affected. Proper diagnosis may help minimize unnecessary investigations and prevent additional psychological stress over whether an underlying disease is present.
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Affiliation(s)
| | - Mary K Dick
- Creighton University School of Medicine, Omaha, NE, USA
| | - Roshan Abid
- Department of Dermatology, University of Iowa, Iowa City, IA, USA
| | | | - Kristen G Berrebi
- Department of Dermatology, University of Iowa, Iowa City, IA, USA.,Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Mary S Stone
- Department of Dermatology, University of Iowa, Iowa City, IA, USA
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Acquired Leukonychia of the Distal Nail Plate: A Morphologic and Proteomic Analysis. Am J Dermatopathol 2019; 42:261-264. [PMID: 31415249 DOI: 10.1097/dad.0000000000001473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Leukonychia, or whitening of the nail plate, is a common disease that was first described in 1919. Leukonychia is classified as acquired or congenital and may be due to abnormality of the nail bed (pseudoleukonychia) or nail plate (true leukonychia). The distal whitened area of the nail plate was clipped from a 31-year-old woman with striated leukonychia and a 32-year-old man and 34-year-old woman with punctate leukonychia. Routine hematoxylin and eosin staining of all clipped samples was performed. A piece of nail with leukonychia and a normal nail from case 2 were sent to the Mayo Clinic for mass spectrometric analysis. On hematoxylin and eosin examination, all leukonychia samples showed odd-appearing eosinophilic linear parakeratinization in the mid-segment of the nail plate. Mass spectrometric analysis of case 2 revealed serum proteins (albumin, serotransferrin IgG, gamma chain, IgG lambda chain, and haptoglobulin) and hair proteins that were not found in the keratin content of the normal nail (keratin type Ha1 and cuticular keratin Ha4). This is the first description of odd-appearing linear parakeratosis and the first proteomic analysis showing abnormal protein content in acquired leukonychia.
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Pakornphadungsit K, Suchonwanit P, Sriphojanart T, Chayavichitsilp P. Hereditary Leukonychia Totalis: A Case Report and Review of the Literature. Case Rep Dermatol 2018; 10:82-88. [PMID: 29805369 PMCID: PMC5968238 DOI: 10.1159/000488522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 01/30/2023] Open
Abstract
Leukonychia is defined as white discoloration of the nails caused by an abnormal keratinization of the nail matrix. Congenital leukonychia totalis is a rare nail disorder, which is typically inherited in an autosomal dominant pattern. This condition can be presented as an isolated condition or in association with systemic diseases. We report a case of a 7-year-old Thai boy who developed asymptomatic white discoloration of all the nails since birth, with an absence of any predisposing factors or associated conditions.
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Mokhtari F, Mozafarpoor S, Nouraei S, Nilforoushzadeh MA. Acquired Bilateral Longitudinal True Leukonychia in a 35-year-old Woman. Int J Prev Med 2016; 7:118. [PMID: 27857831 PMCID: PMC5093880 DOI: 10.4103/2008-7802.193093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/03/2016] [Indexed: 11/04/2022] Open
Abstract
Acquired bilateral longitudinal true leukonychia is a rare disorder. We present a case of a 35-year-old healthy woman presented with this unusual and rare manifestation. She mentioned a history of unprotected exposure to detergents and bleaching chemical agents. Considering her low zinc level, she was prescribed with zinc capsules and recommended to avoid chemical substances for 6 months. During bimonthly follow-up, her zinc level turned normal, and leukonychia subsequently disappeared. Bilateral longitudinal true leukonychia in the nails due to zinc deficiency and exposure to chemical substances has not been reported previously. Direct and indirect effects of chemical substances on matrix and the effect of zinc deficiency on healing process should be considered in these cases.
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Affiliation(s)
- Fatemeh Mokhtari
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Nouraei
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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[Leukonychia totalis]. Hautarzt 2015; 67:308-10. [PMID: 26676417 DOI: 10.1007/s00105-015-3736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Our patient presented with leukonychia totalis at the age of 15 years. Other malformations such as syndromes or underlying internal diseases did not exist. The patient's family history was unremarkable. In the classification of leukonychias, the real, usually hereditary leukonychia can be distinguished from the acquired form. The white color of the nails can be isolated, depending on its present form, appear as part of a syndrome, or as a result of internal disease. An effective treatment of hereditary leukonychia is not known.
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D'Souza P, Khanna U, Kumar Dhali T, Chowdhry S. Idiopathic Acquired Leukonychia Totalis of the Fingernails in a Child Treated Successfully with Zinc and Amino Acid Supplementation. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Idiopathic Acquired Leukonychia Totalis of the Fingernails in a Child Treated Successfully with Zinc and Amino Acid Supplementation. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:444-6. [DOI: 10.1016/j.ad.2014.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/14/2014] [Accepted: 11/22/2014] [Indexed: 11/23/2022] Open
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Canavan T, Tosti A, Mallory H, McKay K, Cantrell W, Elewski B. An Idiopathic Leukonychia Totalis and Leukonychia Partialis Case Report and Review of the Literature. Skin Appendage Disord 2015; 1:38-42. [PMID: 27172289 DOI: 10.1159/000380956] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/13/2015] [Indexed: 11/19/2022] Open
Abstract
Leukonychia totalis and leukonychia partialis are rare nail findings characterized by complete or partial whitening of the nail plate. Leukonychia totalis and leukonychia partialis are usually inherited or associated with systemic disease. Here, we report the case of a 25-year-old man with idiopathic acquired leukonychia totalis and leukonychia partialis and review the literature on this topic.
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Affiliation(s)
- Theresa Canavan
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Antonella Tosti
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Hurst Mallory
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Kristopher McKay
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Wendy Cantrell
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Ala., USA
| | - Boni Elewski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Ala., USA
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10
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Abstract
Nail abnormalities can arise in conjunction with or as a result of systematic pathologies. These pathologies include single-organ diseases, multisystemic diseases, and drug-induced insults. Clinical signs associated with these conditions include dyschromias, vascular alterations, periungual tissue changes, textural dystrophies, contour alterations, and growth-rate alterations. The associated systemic pathologies may affect any part of the nail apparatus, including the nail matrix, the nail plate, the nail bed, the underlying vasculature, and the periungual tissues. The anatomical location and extent of damage determine the clinically manifested anomaly.
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11
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Abstract
Idiopathic acquired true leukonychia totalis is a rare nail disorder not associated with other abnormalities. We present a case in a 12-year-old Egyptian boy.
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Affiliation(s)
- Ola Ahmed Bakry
- Department of Dermatology, Andrology, and STDs, Faculty of Medicine, Menoufiya University, Shebin El Kom, Menoufiya, Egypt
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12
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Kim SW, Kim MS, Han TY, Lee JH, Son SJ. Idiopathic acquired true leukonychia totalis and partialis. Ann Dermatol 2014; 26:262-3. [PMID: 24882988 PMCID: PMC4037686 DOI: 10.5021/ad.2014.26.2.262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/21/2013] [Accepted: 04/22/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Seo Wan Kim
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Mi Sun Kim
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Tae Young Han
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - June Hyunkyung Lee
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Sook-Ja Son
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, Korea
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Dlova NC, Tosti A. Idiopathic acquired true total and subtotal leukonychia: report of two cases. Int J Dermatol 2013; 53:e261-3. [DOI: 10.1111/ijd.12295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ncoza C. Dlova
- Department of Dermatology; Nelson R. Mandela School of Medicine; University of KwaZulu-Natal; Durban South Africa
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL USA
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