Apparent Leukonychia

The cause of apparent leukonychia is an alteration of the subungual tissue, either a vascular abnormality or onycholysis/nail bed hyperkeratosis.

White opacity of the nails in patients with cirrhosis is also called Terry’s nails. In the majority of cases, the nails are of an opaque white colour, obscuring the lunula. This discoloration, which stops suddenly 1–2 mm from the distal edge of the nail, leaves a pink area corresponding to the onychodermal band. It lies parallel to the distal part of the nail bed and may be irregular. The condition involves all nails evenly.

A variation of Terry’s nail is the Morey and Burke type in which the whitening of the nail extends to the central segment with a curved leading edge. Muehrcke’s lines, which are mainly seen in hypoalbuminaemia, run parallel to the lunula and are separated from one another and from the lunula, by stripes of pink nail. They disappear when the serum albumin level returns to normal and reappear if it falls again. It is possible that hypoalbuminaemia produces oedema of the connective tissue in front of the lunula just below the epidermis of the nail bed, changing the compact arrangement of the collagen in this area to a looser texture, resembling the structure of the lunula; hence the whitish colour. The direct correlation between the presence or disappearance of the white bands and the serum albumin level appears to confirm this hypothesis. However, white finger nails preceded by multiple transverse white bands have been reported with normal serum albumin levels. Muehrcke’s lines are common in patients undergoing systemic chemotherapy.

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Transverse Leukonychia One or several finger nails exhibit a band, usually transverse,...
Nail Punctate Leukonychia Punctate leukonychia is characterized by white spots 1–3 mm in...
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