What Causes White Areas On Fingernails?

White areas on fingernails can have various causes, ranging in severity from 'troubling' to 'generally fatal'. Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms. In order to diagnose white areas on fingernails, we could:

Research the topic
Find a doctor with the time
Use a diagnostic computer system.

The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "white areas on fingernails" as a symptom. Here are eight possibilities (more below):

Cirrhosis Of The Liver
Mercury Toxicity
Low Albumin
Ulcerative Colitis
Nephrotic Syndrome
Chronic Renal Insufficiency
Iron Deficiency Anemia
Metal Toxicity

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:

tongue swelling

weak appetite

aluminum-based antacid use

abnormal taste in mouth

showers cause fatigue

edema of the ankles/lower legs

meal-induced pain for 1-4 weeks

jaw lymph node problems

poor bodily coordination

often/always feeling unusually cold

very pale fingernails

chronic mild mouth soreness/sores

... and more than 110 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of white areas on fingernails:

Cause	Probability	Status
Iron Deficiency Anemia	94%	Confirm
Cirrhosis Of The Liver	27%	Unlikely
Low Albumin	23%	Unlikely
Ulcerative Colitis	2%	Ruled out
Chronic Renal Insufficiency	0%	Ruled out
Mercury Toxicity	0%	Ruled out
Metal Toxicity	0%	Ruled out
Nephrotic Syndrome	0%	Ruled out

* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate abnormal fingernails and toenails, The Analyst™ will ask further questions including this one:

Do you have any white areas (not spots) on your fingernails that are not due to nail injury/trauma?

Possible responses:

→ No / don't know
→ Pink at the base, turning white towards the ends
→ 80% or more of nail beds are white, including base
→ White lines from side to side, do not move
→ White lines from side to side, move as nails grow

Based on your response to this question, which may indicate nails turning white towards the ends, nails that are mostly white, stationary white lines across nails or moving white lines across nails, The Analyst™ will consider possibilities such as:

Chronic Renal Insufficiency

Leukonychia (partial or completely white nails) is a sign of renal failure.

Cirrhosis of the Liver

Mainly white nails, or Terry's Nails, are a significant indicator of hepatic cirrhosis. [Terry (1954) Lancet, 1: p.757]

Heavy Metal Toxicity

Mees' Lines (transverse white lines) are a sign of arsenic poisoning.

Hypoalbuminemia (A low albumin level)

Muehrcke's Lines (side-to-side parallel white lines that do not move with nail growth) are caused by a nail bed abnormality, which in turn is probably due to hypoalbuminemia.

Hypoalbuminemia (A low albumin level) also suggests the following possibilities:

Nephrotic Syndrome

Ulcerative Colitis

Iron Deficiency Anemia

Mercury Toxicity (Amalgam Illness)

All heavy metals cause Mees' lines on the nails. These usually begin a few months after significant exposure starts and may be useful in identifying the source of exposure – dental amalgams or some unrecognized source – if you remember when they started.

Concerned or curious about your health? Try The Analyst™