Acquired Idiopathic True Transverse Leukonychia

Area of Science:

• Dermatology
• Nail Disorders
• Medical Case Reports

Background:

• Leukonychia, characterized by white discoloration of the nails, can be congenital or acquired.
• Acquired leukonychia has various causes, including trauma, systemic diseases, and medication side effects.
• Transverse white bands (Mees' lines) are a specific type of leukonychia that warrants careful investigation.

Observation:

• A 34-year-old man presented with a 14-year history of relapsing, remitting transverse white bands on fingernails, sparing toenails.
• The white bands followed the lunula contour, did not fade with compression, and were observed on seven fingernails.
• No onycholysis or other skin lesions were noted. The patient had a history of living with well water and experienced significant stress during university.

Findings:

• Laboratory tests, including complete blood count, liver function tests, lipid panel, and urinalysis, were within normal limits.
• Blood arsenic levels were normal, ruling out arsenic poisoning as a cause.
• Histologic examination of the nail plate revealed segmental parakeratosis, with no fungal organisms detected.

Implications:

• This case highlights a challenging presentation of leukonychia where common causes are excluded.
• The persistent nature of the nail changes despite negative investigations suggests a potential idiosyncratic reaction or an unidentified environmental factor.
• Further research is needed to elucidate the etiology of such idiopathic transverse leukonychia and guide clinical management.