The diagnosis
The patient was given a diagnosis of leukonychia, a benign condition involving white spots or lines in the nails. This young man had transverse striate leukonychia, but if the marks had been white spots, the diagnosis would have been leukonychia punctata.
Leukonychia is common in children and occurs less frequently as people age. Parents may fear that it represents a dietary deficiency (in particular, a lack of calcium), but this concern is unfounded. (The nail does not contain calcium.)
Leukonychia is usually the result of minor trauma to the nail cuticle or matrix. When the lesions are caused by a nervous habit, behavior modification can be helpful. Leukonychia can also be an indirect manifestation of autoimmunity, including alopecia areata or thyroid disease.
In this case, the patient was reassured that this was a nail finding that’s often associated with minor trauma, and not a nutritional deficiency.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Normal nail variants. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:819-821.
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