An Idiopathic Leukonychia Totalis and Leukonychia Partialis Case Report and Review of the Literature

Leukonychia: What Can White Nails Tell Us?

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.

A case of idiopathic acquired leukonychia totalis in a 17-year-old boy

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.

A Review of Nail Dystrophies for the Practitioner

GENERAL PURPOSE

To provide information about nail pathology from its clinical presentation, pathophysiologic origin, clinical diagnosis, diagnostic testing, and treatment.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant should be better able to:1. Review the etiology of and risk factors for the various types of nail pathology.2. Describe the clinical manifestations, diagnosis, and treatment of the various types of nail pathology.

ABSTRACT

Nail pathology has a range of etiologies, from biomechanical trauma to systemic associations. Within this review, nail pathology is examined from a clinical presentation, pathophysiologic origin, clinical diagnosis, diagnostic testing, and treatment standpoint. Nail dystrophy reveals both systemic and exogenous pathology, reinforcing the value of assessing nails during the medical examination.

Acquired Leukonychia of the Distal Nail Plate: A Morphologic and Proteomic Analysis

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.

Onychophagia Induced Melanonychia, Splinter Hemorrhages, Leukonychia, and Pterygium Inversum Unguis Concurrently

Onychophagia, which refers to compulsive nail-biting behavior, is common among children and young adults. Onychophagia can cause destruction to the cuticle and nail plate, leading to shortening of nails, chronic paronychia, and secondary infections. Relatively uncommon effects include pigmentary changes, such as longitudinal melanonychia and splinter hemorrhages. We report a case of a young adult with longitudinal melanonychia, splinter hemorrhages, punctate leukonychia, and pterygium inversum unguis, concurrently induced by onychophagia. Importantly, patients usually do not report this behavior when asked about nail-related changes. Even upon questioning, they may deny nail-biting behavior. As in many other dermatological disorders, dermoscopy can be helpful in the diagnosis of nail disorders.

Hereditary Leukonychia Totalis: A Case Report and Review of the Literature

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.

[Leukonychia totalis]

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.