Striate leukonychia: also known as Mees lines or transverse leukonychia, may follow damage to the nail matrix furrows and ridges may also appear.Punctate leukonychia: occurs after nail biting, manicuring, knocks and bangs, and tight footwear use.Keratin disruption with trapped air within the nail plate, resulting in reflection and lack of transparency. True leukonychia: partial or whole nail plate damage caused by injury to the nail plate or matrix.Its presence may warrant a work-up for systemic disease. White nails can affect anyone of any gender, age or ethnicity. Important to note that congenital leukonychia may also be secondary to systemic disease (see below). Acquired: secondary to systemic disease.This is due to a mutation in the phospholipase C delta-1 gene in which all nails appear milky and porcelain white. Congenital: familial leukonychia is more commonly inherited recessively, although dominant patterns are possible.White nails can be acquired or congenital. Partial leukonychia: 3 subtypes are described. Total leukonychia: whitening of the entire nail plate.This appearance disappears with pressure application on the nail. Apparent leukonychia: secondary to disease of the nail bed.The white nail will not be hidden by pressure application of the nail plate to the bed. True leukonychia: discolouration due to abnormal nail plate keratinisation.Leukonychia can be subdivided into true and apparent discolouration. Leukonychia can be classified by underlying pathology, its distribution, or how it develops. Click here for more images How is a white nail classified?
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