What Do White Spots on the Nails Mean?

White spots on the nails (clinically known as leukonychia) are a common symptom of injuries to the nail matrix or applied pressure. Leukonychia is a medical term derived from the Greek words leuko and onyx, which translates to white and nail, respectively. 

Sometimes, they can be a sign of an underlying health condition. Be mindful that anyone can have the symptom, irrespective of age, gender, or ethnicity.

Take this quiz to find out their possible causes, and the steps that can help restore your nails to the pink of health.

The Different Types of White Spots on the Nails

The appearance of nail spots can be categorised by pathology, distribution, and timeline of development.

Classifying white spots on the nails through pathology

Under the pathology umbrella category, the symptom’s onset can be broken down into true or apparent leukonychia. True leukonychia describes discolouration due to a nail plate’s conversion into keratin. Apparent leukonychia happens when there are abnormalities in the blood vessel arrangement within the nail bed.

Classifying white spots on the nails through distribution

A total or partial nail coverage may help you determine the reason behind the condition. Partial leukonychia can fall under three sub-types. These are: 

• Punctate: Pen-point-sized dots 
• Longitudinal: Lines running across the nails 
• Striate: Singular dots or horizontal bands that are parallel to the nail base

Classifying white spots on the nails based on a timeline of development

Recessive inheritance is a common trait of congenital leukonychia. On the contrary, acquired leukonychia is the by-product of systemic disease.

What are the Primary Causes of White Spots on the Nails?

The most notable triggers of leukonychia are injuries or existing health conditions.

Traditional Chinese Medicine (TCM) perceives white nail spots as an indicator of the Liver’s health. The organ system governs the ligaments and tendons, and the nails are an extension of the tendons. 

Body constitution weaknesses

A healthy circulation of Liver blood plays a pivotal role in maintaining nail and tendon health.

“Changes in nail appearance are usually indicative of a Blood Deficiency. A likely reason for this is fatigue, which may impair circulation to the Heart, Liver, and nail health,” explains Real Health Medical’s Chief Physician Chu I Ta.

Fungal infection

Nail fungus (onychomycosis) is more prominent in toenails than fingernails and grows between the keratin layers in the nail. The condition will eventually produce brown or yellow-coloured nails but will first appear white at the tip of the nail. Toenails may appear flaky and become thick and brittle.

Nail injuries

Trauma is often associated with punctate leukonychia. Slamming your finger in a car door (major trauma) may turn the entire nail white if it detaches from the nail bed. Likewise, habitual nail-biting (minor trauma) can provoke the appearance of white spots.

Trauma also relates to the use of chemical-based products, such as polishes and acrylic nails. Frequent manicures may also cause damage to the nail matrix.

Medical conditions

Severe problems like diabetes, heart failure, and liver disease can be reflected through longitudinal leukonychia. Interestingly, longitudinal and striate leukonychia may also be side effects of chemotherapy. Heavy metal poisoning from arsenic can also cause lines to develop on nail plates.

Nutritional deficiencies

Insufficient calcium, selenium, and zinc can make the nails appear as white-coloured bands or spots.

How Do You Get Rid of White Spots on the Nails?

A Blood Deficiency can be addressed with herbal remedies like Gui Pi Tang (归脾汤) or Si Wu Tang (四物汤). Different internal imbalances may also be associated with white nail spots. These include Blood Stasis, Qi (vital life force) Deficiency, Yin (passive energy) Deficiency, and Phlegm and Dampness. These can be regulated with specific formulas, such as: 

• Blood Stasis: Xue Fu Zhu Yu soup (血府逐瘀汤) or Tao Hong Si Wu soup (桃红四物汤)  

• Qi (vital life force) Deficiency: Bu Zhong Yi Qi soup (补中益气汤) or Yu Ping Feng powder (玉屏风散) 
• Qi Stagnation: Bupleurum Shu Gan powder (柴胡疏肝散) or Xiao Yao powder (逍遥散)  
• Yin (passive energy) Deficiency: Sha Shen Mai Dong soup (沙参麦冬汤) or Zuo Gui pills (左归丸)  
• Yang (active energy) Deficiency: Aconite Li Zhong decoction (附子理中汤) or You Gui Wan (右归丸)  
• Phlegm and Dampness: Warming Gallbladder soup (温胆汤) or phlegm-clearing soup (涤痰汤) 

The clinical treatment of white nail spots rests on the causes of the symptom’s onset. A healthcare provider may choose to use several tests to obtain a diagnosis, such as: 

• Mycology: the study of fungi in nail clippings 
• Nail biopsy: the study of nail tissue 

• Blood tests: to identify the presence of a systemic disease 

Trauma-induced nail spots will naturally resolve on their own. You can manage true leukonychia by avoiding cuticle manipulation and limiting the use of abrasive nail care products. Fungal nail infections may be treated with antifungal medications.

Don’t be alarmed if you find white spots on your nails. Take comfort in knowing that both clinical and traditional medicine takes a holistic approach to alleviate the symptom. Ideally, speak to a licensed TCM practitioner before using herbal remedies to avoid potential contraindications.

If you have family and friends who are experiencing similar changes to their nails’ appearance, share this quiz with them!