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Today I have a male client age 35 who presented with white shiny nails that looked as though they had a coat of translucent nail varnish on them. All the nails fingers and toes were the same, no dystrophy, no flakeyness, no lines. You can see the nail beds blanch when pressed and return a slight pinkness thru the nail. The skin is healthy with no lesions. Below are pictures. Any ideas what this might be? I dont think it is Superficial white onychomycosis and my best guess would be psoriasis although there are no skin lesions or signs anywhere else and it really does not resemble psoriatic nail presentation.

Onset was sudden and 5 years ago while working as a dive leader in Bahamas. He remember using a lot of bleach and heavy duty cleaners on decking etc. He denies any contact with heavy metals and the only medication he takes is ventolin for Asthma. There do not appear to be any other medical problems or signs of systemic disease. He is 175cm tall and weighs 100kg and presently works in the Phillipines as a Dive instructor.







Cheers Dave

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Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

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Hi Dave,

They certainly don`t look fungal or psoriatic to me, no pitting of the nail plates or debris in the sulci. If onset of this leukonychia was sudden, I would be keen to rule out systemic pathology, such as hypoalbuminaemia (any kidney problems?), liver failure (heavy drinker?) or even protein malabsorption. Then again, most leukonychia is classified `idiopathic`.

My first port of call would be further blood tests for anything systemic.

Cheers,
Bel

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Just a rock `n roll refugee.

If...

Thanks for the pics.
Looks like true leuconychia to me, though could be pseudoleuconychia. Agree with Belinda as to possible causes. Also check for: alopecia areata or zinc deficiency.
You can also ask if he took any folk remedies for digestive problems while in Bahamas, as there have been cases of some preparations having high lead content.
Also was he using a high nitrogen, low oxygen mix on the dive it occured?

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Duct tape is like The Force. It has a light side, a dark side, and it holds the universe together.

looks like shark-o foot to me.

Nice one!

Dave

PS thanks Belinda and Kemp, After some interesting research I think I've narrowed it down to leukonychia totalis - irony - totally white nail, oh yeah we already knew that in English i.e all his nails are totally white.

Further questioning today reveals no serious illnesses but he has been prescribed antibiotics in foreign countries, which could have been sulphonamides and he did do a load of cocaine when he was younger and he does drink loads, He's going back to Philippines tomorrow but I advised blood tests for liver and kidney function.

DKS

__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

I'd check his gums as well, run his iron it looks a lot like severe anemia David

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"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright

David G. Wedemeyer, D.C., C.Ped.