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What causes white spots on nails? Related conditions and treatments

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician
Updated May. 8, 2024  •  Published Jan. 12, 2024
Fact Checked
What causes white spots on nails? Related conditions and treatments
In this article:

Overview: What do white spots on nails look like?

White spots on the fingernails or toenails, called leukonychia, are usually nothing to worry about. However, white spots or marks can have different appearances and mean different things. Punctate leukonychia is a single or several visible white spots on one nail. However, other types of leukonychia may include spotting on most of the nail, several nails, or all the nails. The spots may be clustered into bands running across the nail, called transverse leukonychia. The spot might look like a solid band or lines going up the nail (longitudinal leukonychia). Or a big white spot may take up the bottom half of the nail (Lindsay’s nails or “half-and-half” nails). Total leukonychia is when the entire nail turns white. True leukonychia is when the white spot is located on the nail plate. However, the white spot might be on the skin below the nail, which is called “apparent leukonychia.” There may be no spot, just a part of the nail that has pulled back from the skin or an air bubble. That’s called pseudoleukonychia, which means “false white nails.” Continue reading to learn more about possible causes of white spots on nails.

Key takeaways:

  • White spots on nails are a common symptom that may be caused by injury, nail separation, high altitude, trapped air, nutritional deficiencies, infections, poisons, medication side effects, hereditary conditions, autoimmune disorders, blood disorders, neurological disorders, or systemic diseases. 

  • Typically, white spots on nails do not require immediate medical attention.

  • White spots on nails generally do not require treatment, but some underlying causes do. It typically resolves without treatment after the nail completely grows out.

  • Treatments of white spots on nails vary by cause. Read more about treatments for nail fungus, toenail fungus, and psoriasis. 

  • White spots on nails can usually be managed by protecting the nails and fingers from injury.

  • Use coupons for white spots on nail treatments, like terbinafine, ciclopirox, and Jublia (efinaconazole), to save up to 80%.

What causes white spots on nails?

White spots on the nails can have many causes. Most are nothing to worry about, but sometimes they signify a more serious health condition. Causes may include:

Injury

Injuries are the most common cause of nail white spots. Most white spots are due to minor injuries to the nail matrix, the skin at the base of the nail that grows the nail. These injuries are usually due to hitting or squeezing the front of the finger or pushing the nail against a hard object, like tapping nails on a table. Sometimes, the nail itself can be damaged by cosmetics or manicure techniques. Other injuries include:

  • Nail tapping

  • Nail biting

  • Tight shoes

  • Manicuring

  • Chipping off dried nail polish

  • Artificial nail removal

  • Picking or injuring the cuticle near the base of the nail

  • Exposing the hands to toxic chemicals

  • High altitude

  • Dry nails that cause keratin granules (the most common cause is nail polish overuse)

Hormone changes

Hormone changes due to the menstrual cycle or thyroid problems can cause nail spotting. 

Deficiencies

There are claims that white nail spots may indicate a zinc or calcium deficiency, but research doesn’t support these claims. However, white nails are linked with severe vitamin B-3 deficiency and selenium deficiency. 

Infections

Some infections can cause white spots on the nails. The most likely is onychomycosis, a fungal infection of the nail plate. This usually appears as a dense cluster of white spots or bands on a single nail or a few nails, along with other nail changes. Some bacterial infections like tuberculosis and viral infections such as COVID-19 or herpes can sometimes cause white spots that cross the nail from side to side. However, these infections typically have more obvious symptoms.

Medication side effects

Some medications can cause white spots on several or all the nails. In some cases, these medications may turn the nails completely white. These include cancer chemotherapy drugs and retinoids. Heavy metal poisoning, like arsenic or selenium, can also cause white nail spots. 

Autoimmune disorders

Some autoimmune disorders can also cause white spots or white lines on nails. These will probably affect more than one nail, have other symptoms throughout the body, and may have other effects on the nails, such as pitting. These include:

Blood disorders

White spots or bands can also be due to blood disorders, including:

  • Anemia

  • Blood cancers

  • Sickle cell anemia

  • Low levels of blood albumin (hypoalbuminemia). 

Nervous system disorders

People with seizure disorders or peripheral neuropathy may see white spots or bands on their nails. 

“Half and half” nails

Called Lindsay’s nails, the bottom half of the nail experiences discoloration and turns white while the top remains its normal color. Every nail is affected. The most common cause is chronic kidney disease. Other causes include Crohn’s disease, HIV infection, and liver disease. Both kidney disease and liver disease might also produce white bands across the nails.

Entirely white nails

Though not exactly a white “spot,” some people may have totally white nails, called “Terry‘s nails.” Usually, all the nails are affected. Terry’s nails are caused by systemic diseases such as:

RELATED: What causes nail fungus? Diagnosis, prevention, and treatment

Should I be worried about white spots on my nails?

Nail changes can signify a minor injury or a serious medical condition. Generally, a single white spot on a single nail isn’t something to worry about. The more nails that are involved, the more likely there’s a body-wide issue. Other symptoms are a more dependable guide to treatment. If the nails are crumbling, brittle, pitted, or have other problems, see a doctor, dermatologist, or healthcare professional. White bands on many nails, half-and-half nails, and totally white nails should also be evaluated. There will be other symptoms if the problem is due to a more serious condition. Many of those symptoms will be more obvious than nail changes. In these cases, see a healthcare professional. Severe symptoms require immediate medical care.

How is the cause of white spots on nails diagnosed?

To make a diagnosis, a healthcare professional will examine the nails to determine the type of leukonychia and look for other nail changes. The clinician will ask about other symptoms, take a medical history, and possibly perform a physical examination. Other tests may be needed, such as blood tests. If a fungal infection is suspected, the clinician may take a nail clipping for evaluation. If a more serious medical condition is possible, the clinician may refer the case to more specialized healthcare providers.

Are white spots on nails contagious? 

Most white spots on nails causes are not contagious. However, if the cause is an infection, that infection is usually contagious. Nail fungus is particularly contagious, especially if it’s on the toenails. Like athlete’s foot, people get nail fungus by contact with contaminated surfaces like shower floors or towels.

RELATED: Onychomycosis symptoms: what are the early signs of onychomycosis?

How long do white spots on nails last?

White spots on nails will last for as long as something is causing the problem. If the cause is a nail matrix problem, then the white spots will grow out as the nail develops. The same applies to problems with the nail plate. They will disappear as the nail grows out. It takes about four to six months for a fingernail to grow out completely. A toenail takes about 12 to 18 months to grow out completely. If the problem is the nail bed—the skin beneath the nail plate—then the white spots may last until the condition is treated. In some cases, they may last for years or longer.

How to stop white spots on nails

Treatment will depend on the underlying medical condition. For injuries, treatment consists of allowing the nail bed to heal and the nail plate to grow out. People may need to stop certain medications, avoid certain occupations, change their clothing, and avoid manicures or other activities to avoid future injury.

Nail fungus is difficult to treat. Healthcare providers typically use oral antifungal medicines such as terbinafine for several months Even the best treatments are not 100% successful. Topical antifungals are less likely to be used, but daily treatment could last almost a year.

Other medical conditions that cause white spots involve various treatment options. Many of those conditions will be treated by specialists.

RELATED: 15 home remedies for toenail fungus

Living with white spots on nails

If you’re repeatedly experiencing white spots on fingernails or toenails, there are a few measures you can take to prevent them:

  • Don’t tap your nails

  • Don’t push the ends of nails into objects—use the fingertip, instead

  • Don’t use nails as tools to pry things open

  • Wear protective gloves when using household chemicals

  • Don’t pick or chew at the ends of nails

  • Trim toenails regularly

  • Avoid tight shoes

  • Wear some kind of footwear when visiting public pools or showers to prevent a nail fungus infection

  • Give your nails periodic breaks from nail polish

Most importantly, get medical advice about nail changes

All by themselves, white spots on the fingernails or toenails are usually not a cause for concern. Generally speaking, though, the more nails that are affected, the more probable it is that a systemic disease is to blame. This is especially true if there are several nail changes along with other symptoms on the skin or elsewhere. Don’t try to diagnose yourself. Instead, call or visit a healthcare provider who can more accurately pinpoint the cause.

What’s next? Additional resources for people with white spots on nails

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician

Anne Jacobson, MD, MPH, is a board-certified family physician, writer, editor, teacher, and consultant. She is a graduate of University of Wisconsin School of Medicine and Public Health, and trained at West Suburban Family Medicine in Oak Park, Illinois. She later completed a fellowship in community medicine at PCC Community Wellness and a master's in Public Health at the University of Illinois-Chicago. She lives with her family near Chicago.

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