What causes white toenails and how do I fix them?

What do white toenails mean?

The human body is a cleverly designed machine, with each part serving a specific purpose. The nails, both on the fingers and toes, are meant to provide protection for the soft nail bed, reducing the risk of injury. A healthy nail has a nude color, with only the tip being white. A number of medical conditions can cause the toenails to become white altogether, requiring treatment to regain their natural, healthy aspect.

In such situations, it is important to understand that other changes can accompany the white toenails, such as nail thickening, discoloration, or the formation of streaks.

Fungal infection, a common cause of white toenails

When a person suffers from a fungal infection, it can happen that the affected toenails turn completely white. They may also thicken or become brittle, depending on the severity of the infection.

The treatment for a fungal infection is chosen in accordance with how much the respective microorganisms have invaded the nail (and the nailbed as well). Topical antifungal solutions, such as medicated nail polish or cream, are recommended for mild infections, while oral medication is reserved for moderate to severe infections. In cases where the infection is really severe, the doctor might recommend laser treatments or the removal of the affected toenail (partial or complete).

The good news is that fungal infections can be easily prevented, by following a couple of common sense measures. For example, you should wear only socks made from cotton and change them on a daily basis. In regard to footwear, you should avoid wearing tight shoes and throw away any old or worn-out shoes (as these can cause the fungal infection to reoccur).

The antifungal powder can be used for preventative purposes as well, so you can use it daily. Last, but not least, keep your nails trimmed and avoid sharing objects of personal hygiene with other people (the fungal infection can be easily transmitted from one person to the other).

Injuries can lead to white toenails as well

As it was already mentioned at the beginning of the article, our nails serve the purpose of protection against more or less severe injuries. In the situation that our toes are injured, it is possible that the toenails suffer as well, changing their color to white. Even a chipped nail will present a white mark, as a sign of the recent injury. Moreover, if it happens that the injury occurs during the growth of the nail, the injury site will be marked white on the respective nail. The more the toenail will grow, the more obvious the thing is going to be.

How can you determine if the main culprit is a fungal infection or an injury?

First of all, trace back your steps and try to remember if and when an injury has occurred. Second, take a good look at the affected toenail(s). If the problem has been caused by an injury, it is highly unlikely the whole nail will turn white. Instead, you probably have only a small spot or a white mark on the respective toenail(s). A fungal infection, on the other hand, can cause the entire toenail to turn white.

In case of injury, there are no treatment measures that you can take. You have to wait until the nail grows and the white part/mark disappears. You should however be more attentive and avoid similar injuries in the future. By preventing further damage, you will also give the nail the necessary amount of time to grow and be healthy again. It is important to remember and understand that injuries can make toenails prone to fungal infections. Always keep your toenails clean and avoid excess moisture, as such conditions can stimulate fungal overgrowth.

Note: in most situations, the injury to the toenail is caused by an object being dropped on the foot (direct trauma). If bleeding occurs under the nail, this means that blood vessels have been injured as well, causing the nail to turn black as the blood is absorbed. On the other hand, if the trauma is not severe enough to cause bleeding, only white spots will appear on the respective toenails. These are going to disappear, as the healthy nail continues to grow. In case of recurring trauma, as it is the situation with runners who wear inadequate footwear (too small/too tight), white lines can appear on the toenails. This is because the toes keep hitting the end of the shoes, being injured on a regular basis.

Allergic reaction to harmful chemicals

No matter how beautiful nail polish might look on your nails, it is essential to understand that many polishes contain harmful chemicals. These can trigger a serious allergic reaction, causing the nails to become excessively dry and white in color. The main culprit for such problems is formaldehyde, which is often found as an ingredient in nail polishes. Keep in mind that the nail polish remover can lead to similar problems, especially if it contains acetone.

The solution to the problem is to avoid using any nail polish or remover that may contain harmful ingredients. Instead, seek out a nail polish that contains vitamins, nourishing the toenails and keeping them healthy. There are also nail polishes and even removers that contain natural antifungal elements, helping you keep the risk of fungal infections down to a minimum.

Liver disease – white toenails as part of the general symptomatology

Patients who suffer from chronic liver disease or advanced liver failure present a number of symptoms, with white toenails, “Terry’s Nails“, being part of the clinical picture. However, such changes do not occur, until the late stage of the disease and they are not common. Patients diagnosed with liver disease or organ failure present other symptoms, such as nausea, vomiting, jaundice, and abdominal pain. Unfortunately, there is no treatment per se for the white toenails and all the symptoms generally improve with successful liver transplants.

White toenails, a sign of a more serious underlying condition

It is possible that toenails turn a white color, with the tip being either reddened or dark in color. In the medical field, these are Terry’s nails and they represent a sign of a more serious underlying condition, such as diabetes, cirrhosis, or malnutrition. The presence of Terry’s nails can also indicate organ failure, meaning heart, kidneys, or liver. It can suggest that the patient is suffering from iron deficiency anemia, protein deficiency, arthritis or hyperthyroidism. Patients who undergo chemotherapy against different forms of cancer can present such changes as well. In general, the aspect of the toenails improves as the underlying condition is successfully treated or the chemotherapy stops.

Arsenic exposure, a less common cause of white toenails

When people are exposed to arsenic, a number of changes can occur, with the white toenails standing at the top of the list. This is a serious toxic reaction and it requires immediate removal from the primary source. Once the source of toxicity is removed, the nail will grow back, maintaining its healthy aspect and color.

Vitamin or mineral deficiency, causing white toenails primarily in women

If a person suffers from a vitamin or mineral deficiency, it is possible that a number of symptoms will occur. Such changes are more common in women; for example, if one exhibits white marks on the toenails, she might be suffering from calcium deficiency (bone health is affected as well). The same goes for zinc deficiency; apart from the white spots on the toenails, the hair can fall off and the strength of the immune system can be reduced. The easiest method to solve the vitamin/mineral deficiency is to correct the diet or add nutritional supplements.

Things to remember about the health of the toenails

If you want to maintain your toenails healthily and prevent them from turning white, it is important to keep them trimmed and filed (always use a clean, quality file). It is not recommended to cut or push back your cuticles too aggressively, as you will injure the nail bed and cause white spots to appear on your toenails. In order to reduce the risk of discoloration, it is indicated to moisturize your toenails on a daily basis and keep them clean.

In the situation that you suspect the white toenails are caused by a vitamin/mineral deficiency, do not be in a hurry to take nutritional supplements. Go to the doctor and get a complete blood count, so as to see the exact vitamins/minerals that are deficient. Only then, you can adjust your diet or take nutritional supplements, restoring the health of the toenails, among other things.

Natural remedies can be used to improve the aspect of white toenails. Vinegar, diluted in water, can restore the healthy-looking aspect of the nails. In general, it is recommended to soak the affected toenails in water, for about half an hour. The application should be repeated on a daily basis until satisfactory results are obtained. Tea tree oil can do wonders for the health of the toenails; however, it is recommended to be applied to the white toenails only after they have been scraped or soaked in water. Camphol or menthol ointments have antifungal properties and they can be used on white toenails that present a fungal infection (excellent penetration of the nail surface).

What do researchers have to say on the subject?

According to a case study[1] presented by specialists online, it is possible to treat toenail fungus by alternating vinegar and hydrogen peroxide. The person is presented in the case study had a severe fungal toenail infection at the level of the big toe. The infection occurred after a household accident, which led to an injury. The affected toenail turned white, among other changes.

The treatment consisted of alternating vinegar and hydrogen peroxide soaks. What was interesting about this case study was the fact that the press & release technique was used, in order to increase the absorption of the natural remedies at the level of the affected toenail. The technique requires that one press on the toenails, and then release it. The procedure has to be repeated several times, during the actual soak. The authors draw attention to the fact that the two remedies have to be alternated and not used at the same time (this leads to the formation of peracetic acid, which can irritate the skin and the toenails significantly).

A study[2] regarding onychomycosis, presented in the Journal of Fungi, talks about the different types of fungal infections and the characteristic changes the toenails go through. For example, in the situation that the patient suffers from distal and lateral subungual onychomycosis, the toenail plate will turn yellow-white, becoming thickened at the same time.

If the patient suffers from white superficial onychomycosis, the fungi will be present on the dorsal nail plate. The fungal colonies can be identified in the area where the toenail has turned white and opaque. In many situations, these friable patches can be scraped away without any effort. In the case of proximal subungual onychomycosis, the ventral part of the nail plate is affected; the toenail will turn white, in the area which is close to the lunula, being accompanied by acute periungual inflammation. Last, but not least, in the case of endonym onychomycosis, which is one of the rarest forms of toenail fungal infection, the entire nail plate is affected, becoming white and split.

Final word

As you have seen, there are a number of conditions that can cause the toenails to become white. It is important to first diagnose the underlying condition and then seek out suitable treatment. Natural remedies, as well as medical treatments, have to be recommended and supervised by a medical professional.

References:
[1] The efficacy of vinegar and hydrogen peroxide in treating toenail fungus: a case study. 2008. Retrieved from: http://www.michaelandjudystouffer.com/judy/articles/toenailfungus.htm
[2] Onychomycosis: a review. Journal of Fungi, 2015, 1, 30-43. Retrieved from: http://www.mdpi.com/journal/jof