What is your diagnosis? : Journal of the Egyptian Women’s Dermatologic Society

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What is your diagnosis?

El-Komy, Mohamed H.M.

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Journal of the Egyptian Women's Dermatologic Society: September 2018 - Volume 15 - Issue 3 - p 179-180
doi: 10.1097/01.EWX.0000546168.51897.df
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  • The most possible cause of the nail abnormality seen in Fig. 1 is known as which of the following:
    • Superficial white onychomycosis.
    • Trauma.
    • Lichen planus.
    • Subungal hyperkeratosis.
    • Arsenic exposure.
  • This nail sign is known as:
    • Striate leukonychia.
    • Onycholysis.
    • Onychorrhexis.
    • Leukonychia punctata.
    • None of the above.


1: b.

2: d.

Figure 1:
Nail changes on patient dominant hand.


White nails or leukonychia is the most common chromatic abnormality of the nails 1. Leukonychia may be acquired or inherited and can be divided into (a) true leukonychia due to matrix involvement, (b) apparent leukonychia due to subungual tissue abnormality, and (c) pseudoleukonychia due to external factors affecting the nail plate 1.

Acquired leukonychia may be caused by a wide range of abnormalities; however, it is frequently associated with trauma (most common), drugs such as chemotherapeutic agents 2, infections, liver cirrhosis, ulcerative colitis or leprosy, hypocalcaemia and various dermatoses among others 1.

The clinical presentation of leukonychia ranges from complete nail whitening to discrete white punctata or striae 3. True leukonychia punctata is the most common form of leukonychia, in which small white spots appear on the nails as a result of repeated minor trauma to the matrix, such as picking and biting of the nails in young children and nail biters 1,4.

Conflicts of interest

There are no conflicts of interest.


1. Baran R, Dawber RPR, Richert B. Physical signs. Baran & Dawber’s diseases of the nails and their management, Fourth ed. Oxford: Wiley-Blackwell; 2012. 85.
2. Yoruk A, Yukselgungor H. Chemotherapy induced transverse leukonychia in children. Int J Dermatol 2003; 42:468–469.
3. Grossman M, Scher RK. Leukonychia. Int J Dermatol 1990; 29:535–541.
4. Das A, Bandyopadhyay D, Podder I. Idiopathic acquired true leukonychia totalis. Indian J Dermatol 2016; 61:127.
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