All cases were young males with age ranging from 10–35 years at the time of diagnosis, with symptoms first manifesting at age 4-23 years. In our case, age at onset was 14 years. Male predilection may suggest a role for androgens in the disease process or a sex chromosome–based genetic predisposition.[15] In most of the cases, progression was gradual, progressing from leuconyhcia partialis to totalis and from fingernails to toenails. Similar progression was seen in our case. Rapid progression within 1 month was seen in one case [10]. Fingernails were involved in most cases [2,6-9,11, 13,15,16], and some patients had both fingernails and toenails involved [1,3,5,12,14,17,18], similar to our case . In a single patient, only toe nails were involved [10]. In a case reported by D’Souza et al [6], complete resolution was seen after 7 months of zinc and amino acid supplementation.

In our case, no cause or associations was detected on thorough examination and investigations and thus patient was diagnosed as a case of Idiopathic Acquired True Leukonychia Totalis and Partialis. This is a rare clinical entity with nineteen reported cases. Our case is the twentieth addition to the list. It is the first case to be reported from our country, Nepal. We also want to highlight that timely diagnosis and reassurance may help to avoid unnecessary investigations and prevent psychological stress to the patient and family.