Leukonychia Totalis: An Underreported Sign of Chronic Arsenicosis

Arsenic poisoning results from exposure to arsenic through ingestion, inhalation, or skin contact. Cutaneous and neurological symptoms enable early diagnosis. Diagnostic tests include hair, nail, and urine arsenic levels. Leukonychia can be true, apparent, or pseudoleukonychia, depending on the underlying cause.

A 27-year-old male on herbal supplement for bodybuilding, presented with whitish discolouration of nails for 2 years and tingling sensation in extremities for 6 months. Electrophysiological tests indicated symmetric sensorimotor polyneuropathy. Arsenic levels were significantly elevated in hair, nails, and herbal supplements. A diagnosis of chronic arsenicosis with leukonychia totalis and early peripheral neuropathy was made.

Chronic arsenicosis may feature skin changes including pigmentary alterations, palmoplantar keratosis, and the characteristic "raindrops on a dusty road" appearance. Hair loss and nail alterations, such as Mees' lines, are also noted. Arsenic-related neuropathy can be mild or subclinical initially and primarily affects sensory nerve fibres. Total leukonychia due to chronic arsenic exposure has not been reported previously.