What Causes White Toenails? Understanding Potential Reasons Behind White Nail Discoloration

What Causes White Toenails?

White toenails are often a sign of a fungal infection, but there are other potential causes as well. Understanding the reasons behind white toenails can help you determine if treatment is needed.

Toenail Fungus

The most common cause of white toenails is a fungal infection, also known as onychomycosis. Fungi feed on keratin, the protein that makes up your nails. As the infection progresses, the nail can become brittle and crumbly with white, yellow, or brown discoloration.

Toenail fungus thrives in warm, moist environments like swimming pools, locker rooms, and showers. Having athlete's foot or walking barefoot in these areas increases your risk. A weakened immune system, diabetes, or peripheral vascular disease can also make you more susceptible.

In addition to white discoloration, toenail fungus symptoms include:

• Thickened or brittle nails
• Distorted nail shape
• Debris buildup under nails
• Foul odor

Without treatment, the infection can spread to other nails and persist for years. Medicated nail polishes, oral medications, and nail removal are treatment options.

Nail Trauma

Injuries to the toenail can sometimes result in white discoloration. If the nail bed is damaged, the nail may grow back white, distorted, or not at all.

Causes of nail trauma include:

• Dropping something heavy on your toe
• Stubbing your toe
• Playing sports like soccer or football
• Ill-fitting shoes that pinch the toes
• Ingrown toenails

The discoloration from nail trauma is typically temporary. The nail will regain its normal appearance after it fully grows out. Keeping your nails trimmed and avoiding tight footwear can help prevent trauma.

Nail Psoriasis

Up to 50 percent of people with psoriasis develop psoriatic changes in their nails. The immune system attacks the nail matrix, leading to abnormalities in nail growth.

Along with white spots or streaks, psoriasis can cause:

• Pitting or grooves
• Crumbling of the nail edges
• Nail lifting from the nail bed
• Discolored nails

Treatment focuses on controlling the underlying psoriasis with topical creams, light therapy, or oral medications. Your doctor can help find the right treatment to reduce symptoms.

Vitamin or Mineral Deficiencies

Certain vitamin and mineral deficiencies can manifest as white spots on nails. For example, low zinc levels may cause white bands on nails.

Other deficiencies that may cause white discoloration include:

• Calcium
• Iron
• Folic acid
• Vitamin B12

Adding supplements or modifying your diet to increase these nutrients can help resolve the white spots. However, check with your doctor first to identify any deficiencies.

Allergic Reactions

Contact allergens like nickel jewelry, hair dyes, or chemicals found in nail polish, artificial nails, and certain soaps can trigger white spots on nails. These spots develop after exposure to a substance that provokes an allergic response.

Avoiding the allergen is key to preventing further white discoloration. The spots tend to grow out with the nail over time.

Nail Cancer

Although rare, white nails can occasionally signal nail cancer like squamous cell carcinoma. Cancer of the nail bed is usually painless in its early stages.

Signs to watch for include:

• Persistent white/yellow nail discoloration
• Dark streaks or spots on nail
• Nail separation from bed
• Abnormal nail thickening
• Bleeding

See your doctor promptly if you notice any unusual changes to your nails. Early detection and treatment provide the best prognosis for nail cancer.

When to See a Doctor

Schedule an appointment with your doctor if:

• White discoloration affects multiple nails
• Your nails are thickened, brittle, or crumbly
• The white color persists for more than 2-3 months
• You have additional symptoms like pain, swelling, or foul odor
• You have a history of diabetes, vascular disease, or psoriasis

A physical exam and questions about your medical history will help narrow down the cause. Your doctor may clip a nail sample or order lab tests to look for fungal infections or nutrient deficiencies. Be prepared to provide information about any recent nail trauma or potential exposures to allergens.

Diagnosis Options

Tools your doctor may use to diagnose white toenails include:

• Potassium Hydroxide (KOH) Test - Applying KOH to nail clippings can reveal fungal hyphae under a microscope.
• Fungal Culture - Lab analysis of nail samples identifies any fungal growth.
• Biopsy - Removes a small nail sample to examine under a microscope.
• Blood Tests - Assess for diabetes, vitamin deficiencies, and other systemic causes.

Once the underlying cause is determined, appropriate treatment can begin.

Treatment Options

Medications

If a fungal infection is the culprit, your doctor may prescribe:

• Oral antifungals like terbinafine or itraconazole to treat infections from within.
• Topical antifungal nail polish with ciclopirox or amorolfine to apply directly on affected nails.

For bacterial infections, antibiotics may be warranted. Immune-modulating medications help reduce psoriasis and autoimmune-related nail changes.

Nail Removal

In severe cases, the nail may need to be partially or completely removed. This allows the nail bed to be cleaned and medicated. The nail will eventually grow back healthy.

Nail removal can be done chemically or surgically. Your doctor can numb the area to minimize discomfort.

Laser Therapy

Laser treatments apply targeted light energy directly to the nail bed. This process helps kill fungus and facilitates healthy new nail growth.

Multiple treatment sessions are usually required, but laser therapy avoids the need for oral medications in some cases.

Lifestyle Measures

You can reduce your risk of recurring fungal infections or nail trauma with proper nail hygiene:

• Keep nails short and dry
• Wear breathable socks and shoes
• Don't share nail clippers or files
• Disinfect home pedicure tools
• Wear shower shoes in public areas
• Avoid picking at nails or skin around nails

Eat a balanced diet with plenty of vitamins and minerals. Manage underlying conditions like psoriasis or diabetes to support nail health.

Outlook for White Toenails

With proper treatment, white toenails caused by trauma, infection, or deficiency can be reversed. It may take up to 12 months or longer for nails to fully grow out and regain their natural appearance.

Nail fungus has a tendency to recur, especially without diligent nail hygiene. See your doctor promptly if symptoms return.

White toenails linked to psoriasis or cancer may require ongoing management. Follow your doctor's recommendations for medications, treatment, and follow-up monitoring.

In most cases, white toenails are primarily a cosmetic nuisance. With your doctor's help, you can get to the root of the problem and restore the health and appearance of your nails.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.