White Nails
White nails are the most common form of colour change. These can be divided into the following main types:
1 True leukonychia, in which the nail plate is involved.
2 Apparent leukonychia, with involvement of the subungual tissue.
3 Pseudoleukonychia.
In true leukonychia the nail appears opaque and white, probably owing to the diffraction of light in the abnormal keratotic cells; with polarized light, the nail structure appears disrupted owing to disorganization of the keratin fibrils. Total leukonychia, in which the entire nail is affected, is rare. Subtotal leukonychia with incomplete nail plate involvement is more frequent. These forms can be temporary or permanent depending on their aetiology. Partial forms are divided into punctate leukonychia, which is common; striate leukonychia, which is relatively common; and distal leukonychia, which is rare. The term ‘pseudoleukonychia’ is used when fungal infection involves the nail plate, for example in superficial white onychomycoses, or when nail varnish produces keratin granulation. Apparent leukonychia can be further subdivided into a white appearance of the nail due to:
• underlying onycholysis and subungual hyperkeratosis
• modification of the matrix and/or the nail bed, giving rise, for example, to apparent macrolunula.
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