The patient is a 64 yo school teacher who presents for a white nail.
Anamnesis: "The nail has been white for at least 6 months. No other
fingernails or toenails are white. I had a ring on that finger that
got super tight. I have finally removed the ring. Sometimes the finger
hurts, even now, like it may be arthritic."
The patient's questions are:
Is there something I can do to get it back to being a normal color?
Will it ever go back on its own to being normal - no longer white?
O/E: The nail of the 4th finger of the left hand is uniformly white. There is no flaking or friability. Other than the color, the nail plate looks normal. All other finger- and toenails are normal
Photo:
Diagnosis: Ring finger Leuconycia totalis. This does not look like superficial white onycholysis. At the time I saw the patient, I did not think to do a KOK prep since the nail plate looked so normal.
Thoughts: Single-digit leuconychia totalis has not been reported in the medical literature. It is likely that prolonged ischemia may have played a role.
Dr. Eckart Haneke's comments were helpful: "Single digit leukonychia is just a description of the condition, not a diagnosis. I think this is due to the long-term poor blood supply of the finger. There is no similarity to superficial white onychomycosis. I cannot predict the future development. It may get slowly better, but this will take some more time. If you want to know something more about the situation you need a comparative demonstration of the blood circulation, e.g. by thermography or another similar method, of this and the contralateral finger. Diffuse leukonychia is sometimes seen in Raynaud's and other disturbances of blood supply."
Reference:
Leuconychia in reflex sympathetic dystrophy:
a chance association? Vanhooteghem O, et.al.
Br J Dermatol. 1998 Aug;139(2):355-6.
PDF of reference.
Thoughts: Single-digit leuconychia totalis has not been reported in the medical literature. It is likely that prolonged ischemia may have played a role.
Dr. Eckart Haneke's comments were helpful: "Single digit leukonychia is just a description of the condition, not a diagnosis. I think this is due to the long-term poor blood supply of the finger. There is no similarity to superficial white onychomycosis. I cannot predict the future development. It may get slowly better, but this will take some more time. If you want to know something more about the situation you need a comparative demonstration of the blood circulation, e.g. by thermography or another similar method, of this and the contralateral finger. Diffuse leukonychia is sometimes seen in Raynaud's and other disturbances of blood supply."
Reference:
Leuconychia in reflex sympathetic dystrophy:
a chance association? Vanhooteghem O, et.al.
Br J Dermatol. 1998 Aug;139(2):355-6.
PDF of reference.
Fantasy is essentially needed in some difficult situations especially in medicine and every body knows what is a yellow nail syndrome.Hence I think this is the start of yellow nail but the nail changes start as opaque white which gradually become yellowish overtime and other nails will be effected.Please excuse me for my fantasy as I am a POET from Khalifa Sharguie, Baghdad, Iraq
ReplyDeleteform Dr. Ong, Malaysia: "I would watch for vitiligo, which may start anywhere. All of us have seen vitiligo causing local greying of scalp hair, eye brows or even eyelashes. It's analogous."
ReplyDelete