Figure 1: partial to total leukonychia of all finger and toenails
The routine laboratory investigations like complete blood count, liver and renal function tests were done and found to be within normal limits. Hemoglobin was 14.9 gm /dl, total leucocyte count 4800/ mm3, platelets 264000/mm3, total bilirubin -0.5mg/dl, conjugated bilirubin- 0.2 mg/dl, SGPT-15U/L, SGOT-11 U/L, ALP- 81 U/L, urea- 12 mg/dl, creatinine - 0.4 mg/dl, Na- 142, K- 4.0). Further workup including serum albumin, serum calcium, urine analysis, thyroid function test, parathyroid function, chest X-rays, echocardiography, ultrasonography of abdomen and pelvis, iron studies, vitamin assays, antinuclear antibodies did not detect any abnormality. Potassium hydroxide mount and fungal cultures of the nails were negative. So, the diagnosis of Idiopathic Acquired True Leukonychia Totalis and Partialis was made and the patient was counseled regarding the disease. On 1 year follow up, no other changes were noted in the nails. The leuconychia was persistent.