White toenails can indicate a number of different conditions, ranging from harmless to more serious. Some common causes of white discoloration in toenails include:
– Fungal infections like athlete’s foot or toenail fungus
– Injury or trauma to the toenail
– Certain vitamin or mineral deficiencies
– Medical conditions affecting circulation or skin pigmentation
The specific cause will determine the treatment. But in general, white toenail discoloration is usually harmless, especially if it affects only one or two nails. However, it’s a good idea to see a podiatrist if the discoloration spreads, persists for several months, or occurs along with other symptoms. Catching and treating an underlying condition early leads to better outcomes.
What Causes White Toenails?
Here are some common causes of white discolored toenails:
Fungal Infections
One of the most common reasons for white toenails is a fungal infection of the nail bed. The same fungus that causes athlete’s foot can infect the toenails, medical name onychomycosis. The infection causes the nail to detach from the nail bed, allowing air underneath. This air gap appears white.
As the fungal infection worsens, the nail may become brittle and crumbly. Debris can build up under the nail, giving it a distorted, irregular appearance. Usually fungal toenail infections begin at the edges and tips of the nails before spreading to the rest.
Trauma or Injury
An injury, like stubbing your toe, can damage the nail bed and matrix (where new nail cells are made). This disruption in nail growth can result in white discoloration or bands on the nail plate. The discoloration starts at the point of impact and grows out with the nail over time.
Minor traumas usually only affect one or two nails. More serious crushing injuries can damage multiple toenail beds and matrices. The toenails may fall off over time in severe cases.
Nail Polish or Artificial Nails
Using nail polish, acrylics, gel manicures or other artificial nails for extended periods can sometimes cause white spots or streaks. This is due to minor damage to the nail bed and disruption of normal nail growth. Removing artificial nails or nail polish and allowing the nails to grow out naturally usually helps the white marks grow off the nail in a few months.
Vitamin or Mineral Deficiency
Certain vitamin and mineral deficiencies can contribute to white spots on toenails. Lack of zinc, calcium, iron or B vitamins are commonly associated with white discoloration. Brittle, distorted nails can be a sign of general malnutrition.
Getting nutrients from a balanced diet or supplements helps restore normal nail color as the nails regrow. Zinc and biotin deficiencies are especially linked to white spots on nails.
Yellow Nail Syndrome
Yellow nail syndrome is a rare condition characterized by yellow, slow growing thickened nails with a spotted white appearance. It involves poorly functioning lymphatic system along with chronic respiratory conditions like chronic bronchitis. Yellow nail syndrome usually begins in middle age or later.
Along with white, yellowish nails, symptoms involve swelling in the limbs (lymphedema) and recurrent lung and sinus infections. There is no cure for yellow nail syndrome. Treatment focuses on managing symptoms and respiratory infections as they arise.
Psoriasis
Around 50% of people with psoriasis will have psoriatic nail changes. Pitting, distorted thickening, and white spots are characteristic of psoriatic nails. The nail abnormalities reflect psoriasis affecting the nail matrix. Sometimes nail psoriasis occurs independently of skin psoriasis.
Topical corticosteroids and vitamin D creams may improve the appearance of affected nails. Treating the underlying psoriasis is key to preventing recurrence of white spots on nails.
Circulatory Problems
Any condition affecting circulation in the extremities can result in white discoloration of the toenails. Examples include peripheral artery disease (PAD), diabetes, and Raynaud’s disease. Poor blood flow deprives the nail bed and matrix of oxygen and nutrients for healthy nail growth.
Mottled white and brownish nails may indicate underlying vascular insufficiency. Circulation problems usually affect both hands and feet. Managing the underlying condition helps restore blood flow.
Aging
As part of the normal aging process, nails often develop white spots and become more brittle. Older adults are also more prone to fungal nail infections and nail injuries. Age-related changes in nails are harmless, but should prompt close inspection for any abnormal clawing, thickening or distortion.
Chemical Exposure
Chemicals found in cleaning products and solvents can sometimes discolor nails or create white bands when they come into contact with the nails. This irritation is usually temporary and grows out with the nails over a few months. Wearing gloves and avoiding harsh chemicals on the hands and feet prevents this type of damage.
Hypothyroidism
Slow growing brittle nails with white spots or bands may indicate an underactive thyroid (hypothyroidism). Hypothyroidism disrupts nail growth, often leading to concave nail beds and pale nails, too. Treatment with thyroid hormone replacement helps normalize thyroid function and nail appearance.
Kidney Disease
Kidney dysfunction can cause a half-and-half nail, where the proximal half of the nail is white and the distal half is pink. This change is linked to kidney failure, which allows uremic toxins to build up in the blood and alter nail bed pigmentation. Dialysis treatment for kidney failure may help improve the abnormal nail color.
Liver Disease
Nail changes like white nails and Terry’s nails (a dark proximal nail with white tip) can occasionally signal liver disease. With Terry’s nails, the abnormality is thought to be due to vascular changes related to chronic liver dysfunction. Treatment is aimed at the underlying liver condition.
Allergies
Rarely, allergic reactions affect the nail beds and cause white spots or discoloration on the nails. This may be due to the allergy itself or from rubbing and irritation at the nail beds. Avoiding the allergen source and preventing repetitive nail irritation allows the nails to return to normal.
Are White Toenails Always a Cause for Concern?
Not necessarily. Many cases of white toenails are simply due to minor fungal infections, injury or nail polish use. A single affected nail is usually nothing to worry about.
However, pay attention to the following as possible signs of an underlying condition:
– Spreading whiteness affecting multiple toenails
– Discolored toenails plus other symptoms like respiratory infections or swollen limbs
– Very slow growing or distorted, warped nails
– Whiteness involving both toenails and fingernails
– No clear traumatic cause like stubbing the toe
Schedule an appointment with your doctor or podiatrist if you have:
– Persistent white discoloration over several months
– Spreading whiteness to most toenails
– Very slow nail growth
– Distorted thickening or detachment of the nails
– White color plus nail pitting or crumbling
– Additional unexplained symptoms
A medical evaluation can determine if an underlying illness is behind white toenail discoloration in these situations. Timely diagnosis and treatment can prevent permanent nail damage and other complications.
How Are White Toenails Diagnosed?
Podiatrists are specially trained to assess and treat nail conditions. Your doctor will first take a full medical history, asking about:
– Duration of white toenail discoloration
– Which nails are affected
– Any related symptoms like nail odor or texture changes
– Use of nail products, polish or artificial nails
– Trauma, chronic rubbing or pressure on nails
– Current medications
– Existing medical conditions
– Family history of nail disorders
The physical exam focuses closely on the affected toenails. Your doctor will look for evidence of:
– Pitting, detachment or thickening
– Distortion in nail shape
– Irregular surface texture
– Degree of whiteness – complete or in streaks/spots
– Single vs multiple nails involved
– Signs of fungal infection like debris under nail
Your podiatrist may also perform additional tests to help determine the cause:
– **Fungal culture** – Clippings from the nail are sent to the lab to test for fungal infection.
– **Biopsy** – Removal of a small nail sample to examine nail cells under a microscope. This can detect fungal infections, psoriasis, cancers or other nail abnormalities.
– **Blood tests** – Checking blood levels for anemia, thyroid function, diabetes, and kidney or liver abnormalities associated with abnormal nail color or growth.
Combining the medical history, physical exam and tests helps identify causes ranging from vitamin deficiency, to fungal infection, to an underlying illness.
How to Treat White Toenails
Treatment varies depending on the underlying cause of white toenail discoloration:
| Cause | Treatment |
|---|---|
| Fungal infection | Antifungal pills, creams or nail lacquer applied directly to the nail. |
| Injury/trauma | Leave the nail alone to grow out. Trim away any detached nail. |
| Vitamin/mineral deficiency | Oral supplements or improved diet. |
| Poor circulation | Treating the underlying condition like PAD or managing diabetes. Improving blood flow to the extremities. |
| Psoriasis | Medicated creams, light therapy and oral medications to treat psoriasis. |
| Hypothyroidism | Thyroid hormone replacement pills. |
| Kidney disease | Dialysis or kidney transplant. Optimizing kidney function. |
| Yellow nail syndrome | Oral or topical antifungal meds. Controlling respiratory infections. Draining fluid buildup. |
| Aging | No treatment needed. Monitor nails for any distortions or changes. |
| Chemical exposure | Avoid repeat exposure. Let grow out. |
A temporary or fungal cause of white toenails will resolve as the nail grows out over several months. Permanent discoloration may remain if the nail matrix is severely damaged. Prompt treatment helps prevent permanent white lines or spots on the nails.
Prevention
You can reduce the risk of white toenails by:
– Practicing good foot hygiene like washing feet daily, drying carefully between the toes and applying foot powder to prevent dampness. This helps prevent fungal nail infections.
– Disinfecting nail tools and avoiding sharing pedicure instruments.
– Wearing properly fitted shoes and cushioned socks. This prevents repetitive friction and injury to nails.
– Getting adequate vitamins and minerals, especially zinc and biotin, for healthy nail growth.
– Managing any chronic health conditions like thyroid disease, diabetes or vascular disease.
– Avoiding use of artificial nails or nail polish for long periods. Give nails a break to “breathe.”
– Using gloves when working with chemicals to avoid damage from exposure.
– Inspecting feet and nails regularly. Seek early treatment for any abnormal changes.
When to See a Doctor
Schedule an appointment with your doctor or podiatrist if you notice any of the following:
– White discoloration in several toenails
– Whiteness spreading from one nail to others
– Distortion in nail shape or detachment from nail bed
– Very slow nail growth
– Pitting, crumbling or thickened nails
– Discoloration lasts more than 6 months
– Unexplained symptoms along with white nails
Evaluation and testing will determine if an underlying medical condition like hypothyroidism or circulation problems are causing the white toenails. Prompt treatment helps restore nail health and prevent complications.
Even a single white toenail with no other symptoms should be evaluated after several months. Chronic fungal infections can damage the nail permanently without treatment.
Outlook for White Toenails
The prognosis depends on the underlying cause:
– **Fungal infections** – With antifungal treatment, the infection can be cured in about half of cases. The remainder experience chronic recurring fungal nail infections.
– **Injury** – The white discoloration eventually grows out completely as the nail regrows.
– **Nutrient deficiency** – Daily supplements help restore normal nail color and strength within about 2 months in most cases.
– **Medical conditions** – Managing chronic illness improves circulation and nail growth, though some whiteness may remain.
– **Aging** – Age-related white nails are harmless and persist.
For fungal and injury causes, the white discoloration disappears fully as the nail regrows, though it can take 9 months or longer for toenails. Any type of severe injury or damage to the nail matrix may result in permanent whiteness due to disrupted nail growth.
With proper care and follow up, white toenails are usually only a cosmetic concern without serious complications. See your doctor promptly for diagnosis and treatment if you have any uncertainty about the cause.
