These hands belong to a 35-year-old healthy male patient with progressive and persistent total whitening of all the finger nails and the great toe nails since the age of 12 years. The nail changes were a cause of social embarrassments and cosmetic concern to him. He had no significant childhood illnesses, trauma or surgery. He had no addictions. He was not on any medications, systemic or topical, and not exposed to any chemical agents.

Image from Idiopathic acquired persistent true partial to total leukonychia, Shehnaz Z Arsiwala (link)

In true leukonychia, the origin of the white nail plate is in the matrix. As a result of abnormal matrix keratinization, persistent parakeratosis and keratohyaline granules in the nail plate, parakeratosis and dissociation of the keratin bundles may play a role in the modification of the solar light reflection by the ungual plates. Disorganization of the keratin fibrils leads to diffraction of light in parakeratotic cell and the nail plate appears opaque. True leukonychia may be total or subtotal or temporary or permanent. (From Indian Journal of Dermatology, Venereology and Leprology)

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