Are the white spots on the nails really due to calcium deficiency? The nails that really need to be worried are like this...

Rumor: "White spots on the nails mean calcium deficiency"

Many people have heard that if there are small white spots on the nails, it means that the body is calcium deficient. Many people believe it and take calcium supplements.

Rumor analysis: Not true.

White spots on the nails are a very common nail abnormality. It has nothing to do with calcium deficiency, but is mainly caused by nail changes that occur after damage to the nail matrix, that is, usually after local trauma.

There is a widely circulated idea that nails are a barometer of physical health. The implication is that nail problems can reflect the internal health of the body. For example, white spots on nails may be a sign of calcium deficiency. There are other versions of this saying, such as white spots on nails are caused by zinc deficiency, vitamin deficiency, roundworms...

These statements are obviously contradictory and unreliable. Today, we will take this opportunity to talk in depth about calcium deficiency and white spots on nails.

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Importance of Calcium to the Human Body

One of the main reasons why some people worry that white spots on nails are caused by calcium deficiency is that they are worried about their own calcium deficiency and poor nutrition and health.

Calcium is indeed important and is a vital element in the human body. It is mainly found in bones and teeth, helping to maintain their strength. In addition, it plays an important role in blood clotting, muscle contraction, nerve conduction and heart function.

There are two main manifestations of true calcium deficiency. One is the loss of calcium in the bones, causing bone loss or even osteoporosis. The other is a decrease in calcium ions circulating in the blood, resulting in hypocalcemia, which in turn affects the functions of the whole body.

So, what are the specific manifestations of calcium deficiency?

Many people are not aware of the specific effects of calcium deficiency on the body. In fact, mild calcium deficiency usually has no symptoms and is difficult for humans to perceive. If it is obvious calcium deficiency, there may be symptoms such as cramps, facial twitches, tremors, etc. In addition, due to the fragility of bones, it is easy to fracture, tooth loss, and even cause rickets in children. Typical symptoms of rickets include delayed closure of the fontanelle, O-shaped legs, developmental delays, and decreased muscle tone.

In addition, calcium deficiency may have some other symptoms, but these are not specific, which means the matching degree is not high, including: difficulty swallowing, dizziness, anxiety, irritability, low blood pressure, intestinal colic, spinal or hip pain, compression fractures, height loss, etc.

The relationship between calcium deficiency and skin is weaker than you might think. Specifically, there are generally no skin abnormalities after calcium deficiency. If there are, there may be occasional brittle nails, nail separation, and brittle hair (easy to break).

Figure 1. Brittle nails (Source: Reference [8])

Considering that calcium may act in different parts of our central nervous system, specifically on the skin, there may be numbness or tingling in the skin of the limbs (especially the fingers).

It can be seen that nails have little to do with calcium deficiency. This is also easy to understand from a histological perspective, because the main component of nails is not calcium. Calcium only accounts for 0.2% of the weight of nails, which is even much lower than the 10% of sulfur. In addition, calcium is not an important component that determines the hardness of nails, which is completely different from the "protagonist" role of calcium in bones and teeth.

The so-called white spots on the nails have almost nothing to do with calcium deficiency and are often caused by other causes.

What are the white spots on nails?

White spots on the nails are a very common nail abnormality, which is medically called "punctate white nails". This type of punctate white nails is a type of white nails and is also the most common type of white nails.

Figure 2. White nail spots (Source: Reference [9])

It has nothing to do with calcium deficiency, but is mainly caused by nail changes after damage to the nail matrix, that is, it is usually caused by local trauma. Specific trauma scenarios can be seen in the following situations:

· Accidental impact or pinching: Not necessarily a serious injury (in severe cases, there may be subungual bleeding). Sometimes you don’t notice it, and only discover the whitening of the nail after a while.

Nail biting and picking: This is common in children and adults who are prone to anxiety;

· Manicures: Manicures can sometimes damage the nail and the base of the nail (the nail matrix).

The characteristics of this type of white nails are: the location is not fixed, it can be on the fingernails or toenails. The number is also not fixed, there may be only one or two, or there may be more than one. The size is generally 1 to 3 mm, only the shallower layer of the nail is white, not the entire layer, and no matter whether it is pressed or not, the white texture will not change, let alone disappear.

There is another very important point. As the nails grow, these white spots will gradually move toward the distal end, moving an average of 1 to 3 mm per month (the same speed as the growth and renewal of the nails).

In addition to dot-shaped white nails, there are some other white nails that may be a barometer of physical health. For example, when the entire nail is white, we call it "complete white nails" or "full white nails", which may be related to cirrhosis, ulcerative colitis and family heredity.

If most of the nails are abnormal, that is, "partial white nails", it may be related to nephritis, Hodgkin's disease, leprosy, metastatic cancer, etc.

If there are multiple evenly distributed white stripes on the nails, they are called "Mieger lines", which may be related to medication, heart failure, kidney failure, arsenic poisoning or thallium poisoning, etc.

Figure 4. Michaelis lines caused by chemotherapy drugs (Source: Reference [11])

However, the special white nails mentioned above are rare, and there are often other more obvious and more important symptoms, so ordinary people don’t need to worry too much.

There are white spots on nails, what should I do?

If white spots appear on your nails, in most cases, they will gradually disappear as the nails grow. Don't be too anxious or take any medication. Based on my medical experience, I have two suggestions for you:

Step 1: Review your recent life. Think about whether you have recently injured your nails, such as collisions, biting, scratching, or manicures. Try to avoid secondary trauma. Also, pay attention to reducing the frequency of nail contact with chemicals, keep your nails clean, and trim your nails regularly.

Step 2: Observe changes in nails. Pay attention to the type and distribution of white spots. If the white spots continue to grow, or do not move forward slowly with the growth of the nails, it is recommended to consult a doctor. In particular, if there are some chronic diseases (such as liver disease, kidney disease, digestive system diseases) and the disease happens to be poorly controlled, it may be related to changes in nails.

In addition, try to avoid self-diagnosis and treatment. After all, there are many causes of white nails, and it is not recommended to use drugs on your own. If necessary, you can undergo examination and diagnosis under the guidance of a doctor, which is crucial for clarifying the cause and targeted treatment.

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If you are really worried about your calcium deficiency, you also need to conduct targeted evaluations and examinations under the guidance of a doctor. There are many related examination items, such as blood tests for blood calcium, parathyroid hormone, 1,25(OH)2D, alkaline phosphatase, etc., and even bone density tests (an imaging test). Combining these medical tests can better determine whether you are calcium deficient.

After saying so much, what we want to emphasize is that although calcium is essential to the human body, the white spots on the nails have little direct connection with calcium deficiency. These white spots on the nails are usually caused by local injuries such as minor trauma, nail biting or manicure, and the white spots will gradually move to the distal end as the nails grow, and eventually disappear naturally.

Therefore, for most people, white spots on the nails are not a cause for concern. It is important to review recent behaviors that may have caused nail damage and try to avoid them.

When it comes to calcium deficiency, we should also adopt a scientific attitude and conduct professional evaluation and examination under the guidance of a doctor, rather than just judging based on the white spots on the nails (which really doesn't work). Through the right method, we can better understand our physical condition and take appropriate measures to maintain our health.

Looking in the mirror of rumors

Such rumors are often not supported by scientific research and medical evidence. They may simply be based on individual experience, traditional ideas or false information on the Internet. They often link complex health problems to a single cause, such as white spots on the nails are directly related to calcium deficiency. This simple attribution ignores the complexity and diversity of health problems.

References

[1] NHS. About Calcium and Calcium Deficiency. https://www.whittington.nhs.uk/document.ashx?id=1949

[2] UpToDate. Etiology and treatment of calcipenic rickets in children. https://www.uptodate.com/contents/etiology-and-treatment-of-calcipenic-rickets-in-children

[3] Cleveland Clinic. Hypocalcemia. https://my.clevelandclinic.org/health/diseases/23143-hypocalcemia

[4] UpToDate. Overview of nail disorders. https://www.uptodate.com/contents/zh-Hans/overview-of-nail-disorders

[5] Harrison S, Bergfeld WF. Diseases of the hair and nails. Med Clin North Am. 2009; 93(6): 1195-209.

[6] Geizhals S, Lipner S R. Brittle nails[J]. Advances in Nail Disease and Management, 2021: 101-111.

[7] Cashman MW, Sloan SB. Nutrition and nail disease[J]. Clin Dermatol. 2010, 28(4): 420-425.

[8]https://emedicine.medscape.com/article/2500113-overview

[9] https://helloskinderm.com/

[10]https://robzkirsten.wordpress.com/2015/02/26/leukonychia/

[11]https://www.dailymail.co.uk/

Author: Tang Jiaoqing, MD, attending physician of dermatology

Review | Feng Jun, deputy chief physician of the Dermatology Department of Sinopharm Tongmei General Hospital