A Complete Guide to the Causes and Treatments for White Toenails

An In-Depth Guide to White Feet Nails

Looking down at your feet and noticing white spots or discoloration on your toenails can be alarming. Many people's first instinct is to assume it must be toenail fungus. However, there are a variety of potential causes behind white toenails. Understanding the different reasons your nails may turn white will help you get proper treatment and find relief for your symptoms.

In this comprehensive guide, we will cover the various causes of white toenails and how to differentiate between them. We'll also provide insight into prevention and treatment options for restoring healthy, clear nails on your feet.

What Causes White Toenails?

There are several possible explanations for white discolored toenails:

Toenail Fungus

One of the most common culprits behind white nails is a fungal infection. Toenail fungus, known medically as onychomycosis, accounts for around 50% of nail disorders. Fungus causes thickening and discoloration as it invades the nail bed and spreads under and across the nail plate.

In the early stages, you may notice a small white or yellow spot under the tip of your nail. As the fungal infection progresses, streaks, dots, or larger patches of white will appear. Debris can collect under the nail, making it look detached and distorted.

Nail Trauma

Injury to the toenail can also lead to white discoloration. Physical trauma that damages the nail bed can cause bruising or hematomas under the nail plate. This results in white, blackish, or reddish brown staining as the blood gets trapped and dries out.

Repeated trauma from improperly trimmed nails, tight shoes, or dropping objects on your feet creates chronic damage that interrupts normal nail growth. The nail then becomes misshapen, discolored and detached from the nail bed.

Psoriasis

White spots on the toenails may signal psoriasis, an autoimmune condition that causes buildup of skin cells. With nail psoriasis, the problem lies in the nail matrix, where cells multiply rapidly. This leads to abnormalities in nail plate production.

Pitting, crumbling, separation of the nail from the bed, and white patches or dots on the nails are characteristic of psoriatic nail changes. The nails may also become thicker and appear yellowish.

Vitamin or Mineral Deficiencies

Certain vitamin and mineral deficiencies can manifest as white spots on toenails. Lack of zinc, folic acid, iron, calcium or vitamin A, C or B12 interrupts nail development and keratinization.

White bands or streaks that run vertically across the nails may indicate these deficiencies. Horizontal white lines can also appear on the nails.

Aging

As we get older, our nails tend to become duller, darker and develop more ridges and white spots. Nail growth slows down over time, making the nails more susceptible to trauma and infection.

White nails caused by aging may be accompanied by other changes like thickening, crumbling edges, increased brittleness and yellowing.

Other Medical Conditions

Certain medical conditions can manifest through nail abnormalities like white discoloration:

• Kidney or liver disease
• Diabetes
• Thyroid problems
• Anemia
• Eczema
• Lichen planus

Consulting your doctor can help pinpoint if an underlying condition is impacting your nail health and appearance.

When to See a Doctor

Schedule an appointment with your doctor or dermatologist if you notice any of the following:

• White patches appear suddenly or spread rapidly
• Discoloration is accompanied by pain, swelling, or discharge
• You have risk factors like diabetes, immunosuppression, or poor circulation
• OTC antifungals aren't improving the appearance after 3 months
• Nails are becoming thick, brittle and crumbling
• You experience recurring fungal infections

Professional guidance can help determine the underlying cause and rule out any complications. Diabetics in particular should have new nail changes evaluated promptly.

Diagnosing the Cause of White Toenails

To get to the root of what is causing white spots or streaks on your nails, the doctor will begin with a physical exam and ask questions about your medical history. They may also perform the following diagnostic tests:

Fungal Culture

Scrapings from underneath the nail can be sent to the lab to test for the presence of fungus. Culturing the specimen for several weeks allows any fungal organisms present to grow so they can be identified.

Biopsy

A small sample of the nail may be taken and sent to histopathology. Examining the cells under a microscope can help differentiate fungal infection from other conditions like psoriasis.

Blood Tests

Blood work can help uncover any vitamin deficiencies, organ dysfunction, diabetes, or other problems that could be manifesting in the nails.

Once the underlying cause is determined, appropriate treatment can be initiated to help clear up the white discoloration and restore healthy nails.

Treatment Options for White Toenails

Treatments will vary depending on what is provoking the white nail discoloration. Here are some general guidelines:

Fungal Infections

• Topical antifungal lacquers, solutions, or creams containing amorolfine or ciclopirox. Filed down and applied directly to the nail 1-2 times per week for 6-12 months.
• Oral prescription antifungal pills like terbinafine or itraconazole, taken for 6-12 weeks.
• Laser therapy to help penetrate the nail and zap fungal organisms.
• Removal of the infected nail(s) surgically or chemically to eradicate fungus from the nail bed.

Nail Trauma

• Trim nails straight across to prevent ingrown edges.
• Wear proper fitting shoes to avoid repetitive injury.
• Apply nail hardener or adhesive bandages to weak spots.
• Surgery in severe cases to remove and permanently destroy the nail root.

Psoriasis

• Corticosteroid ointments or injections to reduce inflammation.
• Calcipotriol ointment to slow skin cell overproduction.
• Oral medications to treat underlying psoriasis, like methotrexate or biologics.
• Phototherapy light treatments to calm inflammation.

Vitamin Deficiencies

• Oral supplements to increase intake of zinc, iron, folic acid, vitamin A/C/B12, etc.
• Improving diet with nutrient-dense whole foods.
• Treatment for malabsorption issues if present.

Medical Conditions

• Working with your doctor to manage any chronic illnesses like diabetes or thyroid disorders.
• Medications, lifestyle changes, dialysis or surgery if nail changes result from kidney or liver disease.
• Iron supplements, erythropoiesis-stimulating agents, or transfusions for anemia.

Consulting a dermatologist can help develop a tailored treatment plan to address what's causing the white discoloration of your toenails.

Home Care for White Toenails

While seeking professional treatment, you can help improve the appearance of white nails with at-home care:

• Soak nails - 10-15 minutes in warm water with Epsom salt helps soften and remove debris.
• Apply Vicks VapoRub - The thymol has antifungal properties to fight infection.
• Try antifungal tea tree oil - Dilute with a carrier oil and dab on nails 2x daily.
• Trim nails properly - Cut straight across to avoid ingrown edges which can worsen discoloration.
• Buff away thickened areas - Use a nail file gently on surface, dont pick or peel.
• Use nail hardener - Strengthens weak, brittle nails prone to cracking and trauma.
• Avoid picking at nails - This can spread infection; push back cuticles gently with a towel instead.
• Wear clean socks - Change daily to prevent bacteria and fungus buildup.
• Keep feet dry - Moisture worsens many nail conditions.

Practice good hygiene and nail care habits at home to support medical treatment for white toenails.

Preventing White Spots on Toenails

Although not every case is avoidable, you can reduce your risk of developing white toenails by:

• Wearing proper fitting shoes and replacing old shoes regularly to prevent trauma.
• Not picking at your nails or tearing at hangnails.
• Trimming nails straight across and filing away sharp edges.
• Alternating pairs of shoes to allow them to fully dry out.
• Disinfecting pedicure tools and avoiding shady nail salons.
• Treating athletes foot and other fungal infections promptly.
• Throwing away old socks and replacing frequently.
• Drying carefully between the toes after bathing or swimming.
• Avoiding walking barefoot in locker rooms, pools, etc.
• Getting white spots evaluated promptly by your doctor.

Protect your feet from injury and infection to help keep your toenails healthy and clear.

When to Seek Emergency Care

Seek urgent medical care if you experience:

• Sudden discharge of pus from the nail.
• Bleeding, increasing pain or swelling in the nail.
• Red streaks extending from the nail up the foot or leg.
• Fever, chills, or flu-like symptoms along with the nail changes.
• Difficulty walking or bearing weight due to nail pain.

These can indicate a serious nail or fingertip infection requiring emergency treatment to prevent complications like cellulitis or sepsis.

Outlook for White Toenails

The prognosis for white toenails depends on the underlying cause:

• Fungal infections - With aggressive topical or oral antifungal treatment, new clear nail can regrow over 12-18 months.
• Trauma - Damaged nails may fall off completely and regrow if the matrix isnt permanently destroyed. Preventing further injury is key.
• Psoriasis - Topical medications and phototherapy can help with flares but not cure the condition. Managing the psoriasis is important.
• Deficiencies - Supplementing the nutrients commonly resolves white spots within a few months as new nails grow in.
• Aging - Nail discoloration and brittleness tends to progressively worsen over time.
• Medical conditions - Improving control of the underlying disease can help normalize nail changes.

Consult a dermatologist if at-home care and OTC treatments dont improve white toenails within 3-6 months. Seeking professional guidance provides the best chance of restoring clear, healthy nails.

When to Talk to a Dermatologist

See a dermatologist promptly if you notice:

• Sudden nail separation, discharge or foul odor
• Rapid worsening of discoloration or thickness
• Spread to multiple nails
• Bleeding, tenderness or redness around the nail
• Risk factors like diabetes or immunosuppression
• No improvement after 3-6 months of self-treatment

A dermatologist has specialized training to diagnose nail conditions. They can provide prescription medications and procedures to help resolve persistent white toenails caused by fungus, psoriasis or other medical problems.

When to Consider Nail Removal

If other treatments fail, your doctor may recommend partial or complete surgical nail removal (onychectomy) for severe or recurrent cases. This is considered for:

• Fungus continuing to spread despite oral antifungal treatment
• Persistent traumatic damage or distortion of the nail
• Severe pain, inflammation, or infection of the nail
• Nail abnormalities caused by tumors or other growths

The nail can often regrow after removal, but in some cases the nail matrix is permanently destroyed to prevent recurrence.

Coping with Embarrassment About White Toenails

White or discolored toenails can cause feelings of shame or embarrassment, but know that you're not alone. Some tips for coping emotionally:

• Remind yourself it's a common medical issue and doesnt define you.
• Open up to friends and family to receive support.
• Try pedicures with opaque polish to conceal discoloration.
• Focus on progress of treatment rather than fixating on appearance.
• Wear socks at the pool or beach to keep feet covered if it causes anxiety.
• Consider counseling or support groups to boost self-esteem.

Approaching nail changes with compassion and patience helps promote confidence from the inside out.

In Conclusion

Noticing white spots, streaks or patches on your toenails can be alarming but try not to panic. The most likely causes are fungal infection, repetitive injury to the nail, psoriasis or vitamin deficiency. Keeping feet protected and getting prompt treatment provides the best chance of restoring healthy, clear nails. Working with both a doctor and dermatologist can help diagnose the root cause and find relief from embarrassing white toenail discoloration.

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.