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.