What Causes White Spots on Nails?

White spots on nails (known as leukonychia) are a common condition that may affect one nail or multiple nails. Leukonychia may appear as spots, bands, or streaks.

Leukonychia is generally harmless and often caused by bumping a nail on a hard surface. However, white spots on nails can also be caused by fungi, underlying diseases, allergies, and medications. While white spots often resolve on their own, some require medical treatment.

There are three different types of leukonychia:

• True Leukonychia In true leukonychia, white spots appear due to injury or other issues that affect the nail matrix (the half-moon shape at the base of the nail) or nail plate (the visible portion of the nail that extends from the nail matrix to the edge of the nail).

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• Apparent Leukonychia The white spots are caused by changes in the skin under the nail (the nail bed). The discoloration is due to the compression of blood vessels.

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  Apparent leukonychia can be a sign of underlying disease, such as chronic liver disease or diabetes.

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• Pseudoleukonychia White spots form on the surface of the nail due to external organisms like fungi.

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“There are several causes of white spots on nails — few of which are problematic,” says Chris Adigun, MD, a board-certified dermatologist at Dermatology and Laser Center of Chapel Hill in North Carolina who specializes in nail disorders. Here are possible causes of white spots on nails:

• Injury Injury to the nail plate or matrix is one of the most common causes of leukonychia, says Shari Lipner, MD, PhD, associate professor of clinical dermatology and director of the nail division at NewYork-Presbyterian and Weill Cornell Medicine in New York City. For example, banging a nail against a hard surface or closing it in a door.
• Nail Polish Prolonged polish wear can cause small white areas to form on the nail surface due to the nail plate becoming excessively dry when under nail polish for a long time, says Dr. Adigun. Removing polish with acetone-based nail polish remover can worsen dehydration.
• Medications White spots on nails are a common side effect of chemotherapy medications. Chemotherapy can interfere with the division of the nail matrix cells that eventually form the nail plate. However, the nail changes typically resolve once chemotherapy treatment ends.

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   Some medications used to treat bacterial infections (such as those used for a urinary tract infection) can also cause white spots.

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• Fungal Infection White spots on the nails due to fungal infection (known as onychomycosis) typically begin as a white or yellow-brown spot under the tip of the nail.

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   Over time, the nails develop a powdery consistency due to the fungus digesting nail material from the superficial portion of the nail plate, says Adigun. Onychomycosis can be caused by different fungi, including dermatophytes.

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  These are organisms that cause fungal infections like ringworm and athlete’s foot.

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• Nutrient Deficiencies Some believe that nutrient deficiencies can cause white spots on nails, but Adigan notes that this is a myth. Still, vitamins and minerals do play an important role in nail growth. If you have a malabsorption disorder that impairs your body’s ability to absorb nutrients like zinc and selenium, you may be more likely to develop leukonychia.

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• Allergies Some people are allergic to ingredients in nail products such as nail polish, nail polish remover, and acrylic nails. Using these products may cause white spots to develop.

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• Nail Psoriasis Sometimes, apparent leukonychia is a symptom of nail psoriasis, an autoimmune condition that causes nail cells to grow too fast. The nails may develop yellow, red, pink, or brown spots or grooves that run horizontally across the nail plate (known as Beau’s lines). Nail psoriasis is more likely to appear in people who have psoriasis (a skin disease that causes an itchy rash on the knees, elbows, trunk, or scalp) or psoriatic arthritis (joint pain and inflammation in people with psoriasis).

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• Underlying Health Conditions Health conditions such as liver disease, chronic kidney disease, congestive heart failure, hyperthyroidism (a condition where the thyroid gland makes too much thyroid hormone), and diabetes can contribute to the development of white spots on the nails, says Dr. Lipner. For example, the thyroid gland affects the growth of keratinocytes, the protein cells that make up nails.

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• Poisoning Symmetrical white bands that run parallel with your cuticles (known as Mees’ lines) can form if you’ve ingested a heavy metal like arsenic or lead, says Adigun. Heavy metal poisoning has multiple causes, including consuming contaminated water. White spots caused by heavy metal poisoning are typically accompanied by other symptoms, including abdominal pain, chills, diarrhea, weakness, nausea or vomiting, scratchy throat, or numbness or prickly sensations in the hands and feet.

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• Illness or Stress Severe emotional trauma, stress, or illness can disrupt nail growth and cause Beau’s lines. “These are more often indentations, but may appear white,” says Adigun.

Leukonychia is typically diagnosed by a board-certified dermatologist.

Your provider will conduct a physical exam that may include placing pressure on your nails, as this helps identify the type of leukonychia and narrow the list of potential causes. If it’s apparent leukonychia, the white shade will change when you press on the nail, says Adigun. If it’s true leukonychia, the color will stay the same when pressure is applied.

In addition to a physical exam, your provider may conduct one or more of the following tests to determine the underlying cause of leukonychia:

• Nail Clipping A nail clipping is a simple, painless method for diagnosing fungal infections. This technique involves clipping off a fragment of an affected nail to be viewed under a microscope.

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• Blood Test Your healthcare provider uses a thin needle to draw blood from your arm. This blood sample is then checked for chronic conditions like diabetes and kidney disease.

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• Culture Test To check for fungi, your healthcare provider will clip off parts of your nails. The clippings are sent to a laboratory to test for the presence of fungi.

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White spots on nails often resolve on their own. “If it is trauma-related, then it will go away as the nails grow,” says Lipner. If they are caused by nail polish, then you can either wait for them to grow out or stop wearing polish and diligently hydrate your nails, which should improve their appearance.

Fingernails typically grow out in about six months, while toenails grow out in about 12 to 18 months, says Adigun. However, the exact time it takes to grow out a white spot depends on how far up the nail the spot appears. For example, if the white spot is in the middle of the fingernail, it might take only three months to grow out.

If you have an allergy to an ingredient in a nail product, you’ll want to avoid that specific ingredient. A dermatologist can help you identify what’s causing the problem.

Follow these expert nail care tips to help protect your nails from white spots:

1. Avoid trauma to the nail. Accidents can’t always be prevented. Still, you can reduce your odds of injuring your nails by wearing protective gloves and shoes when working outside or using tools like a hammer. Take care when moving heavy objects and playing sports.

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2. Limit nail polish and polish remover. The idea is to avoid drying out the nail with these products, so give nails a break from polish for a couple weeks. However, if you like the look of polish on your nails, feel free to polish over white spots. “If you’re attached to polish, you’re not causing harm,” says Adigun.
3. Eat a balanced diet. A healthy diet supports proper nail growth, though it won’t affect white spots specifically, says Adigun.
4. Care for nails. Keep your nails dry and clean to prevent fungi from growing. To keep the nails from drying out, be sure to moisturize daily.

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    “Keeping the skin around the nail and the nail plate itself well moisturized — and doing this diligently for a couple weeks — will keep your nails in better shape,” Adigun adds. She recommends using plant-based products like coconut oil.

See a board-certified dermatologist if white spots on nails don’t improve within two months, says Lipner.

• White spots on nails (leukonychia) are common and can appear as spots, bands, or lines.
• Leukonychia can be caused by injury to the nail, prolonged nail polish wear, fungal infection, underlying health conditions, nutrient deficiencies, allergies, stress or illness, medications, nail psoriasis, or heavy metal poisoning.
• See a board-certified dermatologist if white spots don’t improve within two months, you notice other nail changes, or white spots appear alongside serious symptoms such as weakness or fatigue.