Hi Folks,
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I have a 34 yr old female patient with bilateral white nails. She came to see me this morning c/o ingrowing nails, which turned out to be minor distal o/c.
the bigger problem is the colour of the nails and state. All toenails are affected, with both hallux nails the worst affected. There is a white discolouration to the nail plates with thickening and involution. The distal ends of all toes are red and appear inflammed.
There is no apparent sepsis, the patient has had this problem for approximately 3.5 years (coincides with birth of 1st child), with no previous treatment. She has had 4 children, the first born in July 2008, and the last born 8 months ago. No history of cardiac or respiratory problems, patient was unsure regarding liver function. She is not any specific diet and believes she eats healthily. She has no known allergies and is taking Eglinol for breastmilk production and Pregnavit - multivitamin pre and post pregnancy.
Any ideas ???? is it as simple as leukonychia?
i've attached some pics. the big toenails look rough and pitted, this is due to the patient roughing it with sandpaper after nail varnish removal.
regards,
Byron Starkey
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