Leukonychia totalis is a condition where all or nearly all of the fingernails, toenails, or both look white. It can be present from birth or appear later in life, and it may affect children or adults depending on the cause. In plain terms, leukonychia totalis is usually a nail color change rather than a dangerous illness, and many people have no pain or other symptoms. It is not usually life-threatening, and treatment depends on what is causing leukonychia totalis, so care may range from simple reassurance to treating an underlying health problem. If you notice ongoing white nails or other early signs of leukonychia totalis, it may be worth checking in with a doctor.
How many people live with Leukonychia totalis?
Global and U.S. prevalence estimates for leukonychia totalis are not consistently reported by a single authoritative source, so there is no dependable count of how many people are living with it worldwide or in the United States. It is generally described as extremely rare, and the medical literature is made up mostly of reports of individual people or families rather than population-wide counts.
Overview
Leukonychia totalisSymptoms
Leukonychia totalis causes all or nearly all nails to look white from the nail plate itself. In many living with leukonychia totalis, this is present from birth or early childhood, while the nails otherwise usually grow normally.
Outlook and prognosis
Leukonychia totalis usually affects nail color rather than overall health, so daily life and life expectancy are typically normal. Outlook depends on the cause: inherited cases are often lifelong, while acquired changes can improve if the trigger is treated.
Causes and risk factors
Leukonychia totalis is usually caused by a gene change present from birth, often inherited and sometimes new. It can also appear with nail injury, medicines, low protein, or certain long-term illnesses. Family history raises risk.
Genetic influences
Genetics can be very important in leukonychia totalis, especially when it runs in families from birth or early childhood. Some inherited gene changes can cause leukonychia totalis on their own or as part of a broader syndrome, while others develop it without a clear genetic cause.
Diagnosis
Diagnosis of Leukonychia totalis usually starts with the nail changes seen on exam and a review of family history. Doctors may confirm it with genetic tests and, when needed, tests to rule out injury, infection, or other nail conditions.
Treatment and drugs
Leukonychia totalis itself usually does not need medicine. Care focuses on finding and treating any underlying cause, such as injury, illness, or medication effects. For many living with leukonychia totalis, gentle nail care and regular checkups are enough.
Symptoms
Many people with Leukonychia totalis notice that all or nearly all of their nails look milky white, which can be surprising even when the nails feel normal. For many people with Leukonychia totalis, the change is mostly in appearance rather than pain or loss of nail function. The early features of Leukonychia totalis often show up in childhood in inherited forms, but some people develop white nails later in life.
The nail often looks solid white from the base to the tip, rather than having a few small spots or lines. The color usually stays white as the nail grows out.
Leukonychia totalis usually affects all or nearly all fingernails, and toenails may also be involved. The change often appears on both sides in a fairly even way, instead of staying limited to one nail.
In inherited cases, the white nails may be present at birth or appear in early childhood. In acquired cases, the change can begin later in life and may become noticeable over weeks or months.
Most people with Leukonychia totalis do not have pain, itching, swelling, or tenderness in the nails. Many first notice it during everyday grooming, such as trimming nails or putting on nail polish.
How people usually first notice Leukonychia totalis?
For many people, the first signs of leukonychia totalis are simple but striking: the nails gradually look solid white from base to tip instead of their usual pink-and-clear color, often across most or all fingernails and sometimes the toenails too. When it begins in infancy or childhood, families or doctors may first notice that the nails look chalky, porcelain-white, or unusually pale during routine care, even though the nails may otherwise feel normal and painless. If this change appears later in life rather than being present early on, that is often how leukonychia totalis is first noticed and why a clinician may look more closely for an underlying cause.
Types of Leukonychia totalis
No distinct types of leukonychia totalis are widely recognized.
Can I slow down the onset of symptoms?
Usually no—there is no good evidence that lifestyle changes or medicines can meaningfully delay the start of leukonychia totalis, especially when it is inherited. If the white nails are acquired rather than inherited, treating the underlying cause and avoiding repeated nail injury may help reduce worsening in some people, but that is not the same as preventing it, and the evidence is limited. There are no standard preventive drugs or screening programs for this condition, but an early checkup can help look for a treatable cause and give you a clearer idea of what to expect.
What genetics can tell you about symptoms
Genetics can sometimes explain whether leukonychia totalis is limited to the nails or comes with other health features, such as changes in the skin, hair, or hearing, depending on the underlying gene involved. In inherited forms, the whitening of all nails often starts at birth or in early childhood, and genetic differences may influence how complete the whitening is and whether other symptoms appear. For many people, though, genetics mainly helps clarify the pattern and cause rather than predict day-to-day symptoms beyond the nails.
Causes and risk factors
When people look for the causes of leukonychia totalis, genetics is one possibility because it can run in families or start from a new gene change. It can also happen after repeated nail injury, frequent exposure to harsh chemicals, or certain medicines and toxins. Some medical problems are linked with leukonychia totalis too, especially poor nutrition and some liver, kidney, or skin conditions. Think of risk factors as pieces of a puzzle, not the whole picture. Talk with your doctor if all nails become white, because finding the cause can guide treatment and check for a broader health problem.
What are the most common causes or risk factors?
Leukonychia totalis, which means all the nails look white, is most often inherited and can run in families because of a gene change that affects how the nails are formed. When it is not inherited, it is much less common and may be linked to repeated nail injury, certain medicines, or underlying health problems such as low protein levels in the blood, liver or kidney disease, or metal poisoning. The main risk factors are having a family history of it or having one of these related health conditions.
Environmental and biological risk factors
Leukonychia totalis is uncommon, and the causes of leukonychia totalis can range from health conditions inside the body to outside exposures that affect how nails are made. Doctors often group risks into internal (biological) and external (environmental). When all nails turn white, the pattern often prompts doctors to review recent illness, medicines, and possible exposures.
Conditions that lower blood protein, especially albumin, can interfere with normal nail formation and are linked with widespread white nails. This is more likely when the underlying illness is significant or lasts for a while.
Ongoing liver disease or kidney disease can raise the chance of diffuse white nail changes, including leukonychia totalis. Doctors usually look for this alongside other signs of illness rather than from the nails alone.
Some inflammatory conditions, including bowel disease, have been reported in people with leukonychia totalis. The link may relate to periods when inflammation disrupts normal nail growth.
Serious infections, high fevers, or major illness can temporarily disturb the nail matrix, the area where nails are formed. For some people, the white change becomes noticeable weeks later as the nail grows out.
Genetic risk factors
When all or nearly all nails are white from childhood, genetics are often part of the explanation in leukonychia totalis. Some risk factors are inherited through our genes. The main genetic causes of leukonychia totalis are changes in genes involved in nail formation, and the condition may appear on its own or as part of a broader inherited syndrome. A family history raises the chance, but some people are the first in their family to have it because a new gene change can happen.
PLCD1 changes: The best-known genetic cause of isolated leukonychia totalis is a change in a gene called PLCD1, which helps nails form normally. When this gene is altered, nails may grow in white from early life even when there are no other health problems.
Dominant pattern: In some families, leukonychia totalis follows an autosomal dominant pattern, which means one changed copy of the gene can be enough to cause it. If a parent has this pattern, each child has a 1 in 2, or 50%, chance of inheriting the gene change.
Recessive pattern: In other families, leukonychia totalis is autosomal recessive, so a child needs two changed copies of the gene. Parents may carry one copy and have normal-looking nails, and if both parents are carriers each pregnancy has a 1 in 4, or 25%, chance of the condition.
Syndromic forms: Sometimes white nails are part of a broader inherited syndrome rather than a nail-only condition. In these rare cases, the same genetic change may also affect hearing, skin, or other body systems.
New change: A person can have leukonychia totalis because of a new genetic change that was not inherited from either parent. This can explain why the condition appears even when no one else in the family has white nails.
Lifestyle risk factors
For leukonychia totalis, lifestyle habits are usually not the main cause, especially when it is inherited from birth. Still, how lifestyle affects leukonychia totalis can matter because repeated nail damage, chemical exposure, and poor nutrition may worsen nail changes or contribute to acquired white nails. In people with long-standing nail whitening, daily habits can also affect how healthy new nail growth appears over time.
Repeated picking, biting, aggressive manicures, or frequent artificial nails can injure the nail matrix and make white nail changes more noticeable. Ongoing trauma may slow normal regrowth and make it harder to tell whether leukonychia totalis is stable or getting worse.
Frequent contact with nail cosmetics, solvents, acrylics, gels, or harsh removers can irritate or damage the nail unit. In some people, this can worsen acquired whitening or brittle nail changes that overlap with leukonychia totalis.
Low protein intake or deficiencies such as zinc or iron deficiency can impair normal nail formation and contribute to pale, weak, or abnormally growing nails. While this does not cause inherited leukonychia totalis, it can make nail appearance and regrowth poorer.
Heavy alcohol use can affect liver health and nutrition, both of which can change nail appearance. This may add other whitening or nail abnormalities that complicate the picture in someone with leukonychia totalis.
Risk prevention
Leukonychia totalis is not always something you can prevent. If it is inherited, the nail whitening itself usually cannot be stopped, so care is more about avoiding nail damage and checking for related health issues when needed. In acquired cases, lowering risk means protecting the nails, limiting exposure to irritants, and treating any underlying medical problem early. Prevention is about lowering risk, not eliminating it completely.
Some people with leukonychia totalis have a genetic form, which cannot usually be prevented. If white nails appear later in life, a medical review can help look for acquired causes such as injury, medicine effects, or other health conditions.
Repeated trauma from biting, picking, aggressive manicures, or tight shoes can damage the nail matrix where the nail is made. Gentle nail care may lower the chance of acquired leukonychia totalis or keep it from getting worse.
Frequent contact with nail cosmetics, solvents, cleaners, and other irritants can stress or injure the nail unit. Using gloves for wet work and giving nails breaks from products may help reduce risk.
In some cases, leukonychia totalis is linked with nutritional problems, infections, or broader medical conditions rather than the nails alone. Treating the underlying issue early may prevent persistent whitening, especially when the early symptoms of leukonychia totalis start after previously normal nails.
Can you prevent Leukonychia totalis?
Not always. If leukonychia totalis, meaning the nails turn completely white, is inherited, it cannot be prevented; when it is linked to another health problem or repeated nail damage, treating the cause and protecting the nails from injury and harsh chemicals may help lower the risk, but it is not guaranteed to prevent it.
Transmission
Leukonychia totalis is not infectious, so it cannot be caught from touching someone, sharing nail tools, or being near them. For many living with leukonychia totalis, the more useful question is how leukonychia totalis is inherited: hereditary cases can run in families and are often passed from a parent to a child through a change in a gene.
Sometimes that gene change happens for the first time in one child, so there may be no earlier family history. Not all leukonychia totalis is inherited, though; some cases are acquired later in life because of another health condition, medicines, or exposures, and those cases are not passed from person to person.
When to test your genes
Consider genetic testing if leukonychia totalis runs in your family, started early in life, or appears with other findings such as hearing changes, skin or hair differences, or developmental concerns. Testing can help confirm whether it is isolated or part of a broader genetic condition, which may guide follow-up care.
Diagnosis
Leukonychia totalis is usually diagnosed by looking closely at the nails and checking whether the whitening affects all or nearly all of the nail plate. In day-to-day life, this may first come up when someone notices every fingernail looks chalky or milky white for months, even though the nails are not dirty or injured. Doctors usually begin with the nail changes themselves, then use your medical history and, if needed, a few tests to confirm the diagnosis of leukonychia totalis and look for an underlying cause.
The diagnosis often starts with a careful exam of the nails to see whether the nail plate is diffusely white from side to side and base to tip. This pattern helps separate leukonychia totalis from surface staining, fungal infection, or whitening that only affects part of the nail.
A detailed family and health history can help show whether the whitening has been present since childhood or appeared later in life. Doctors also ask about nail trauma, medicines, chemical exposure, skin disease, and other symptoms that could point to an acquired cause.
The clinician usually examines the skin, hair, mouth, and the rest of the body for clues that the nail change is part of a broader condition. This matters because some people with leukonychia totalis also have other findings that help guide further testing.
Doctors look for whether the whiteness is coming from the nail plate itself or from the nail bed underneath. This simple distinction helps rule out other causes of white nails, such as illnesses that change blood flow or protein levels.
How is Leukonychia totalis diagnosed?
Leukonychia totalis is usually diagnosed by looking closely at the nails and asking when the whitening started, whether all nails are affected, and whether there has been injury, illness, medicine use, or a family history of similar nails. A doctor may gently press on the nail and, if needed, do blood tests or take a small nail sample to check that the whiteness is coming from the nail itself and not from another nail problem or a health condition. Genetic testing may be considered if it starts in childhood or seems to run in the family, but many people are diagnosed based on the nail changes and their medical history.
Stages of Leukonychia totalis
Leukonychia totalis does not have defined progression stages. This is because it is usually a nail appearance change rather than an illness that steadily worsens over time, although the whitening can be present from birth or appear later depending on the cause. Doctors usually start with a conversation about when the nails turned white, whether all nails are involved, and whether there are other symptoms, because the early signs of leukonychia totalis are usually the nail color change itself. Diagnosis is usually based on examining the nails and checking for possible triggers such as injury, medicines, low protein levels, or inherited conditions, and follow-up depends on whether an underlying cause needs treatment.
Outlook and prognosis
The outlook for people with leukonychia totalis is generally excellent, because the nail color change itself is usually benign and does not damage overall health. Prognosis depends mainly on the underlying cause: inherited isolated leukonychia totalis often remains stable throughout life, while acquired cases may improve if a trigger such as trauma, medication exposure, or nutritional deficiency is corrected. The condition can persist long term, especially in genetic forms, but it typically does not affect life expectancy. Mortality is not associated with leukonychia totalis itself; any serious risk would come only from a separate underlying disorder if one is present. In most cases, management focuses on evaluation for associated conditions and reassurance about the cosmetic nature of the nail findings.
Long-term effects
For many people, the main long-term effect of leukonychia totalis is that the nails stay completely white over many years, often from childhood onward. In isolated leukonychia totalis, the change is usually limited to appearance rather than nail function, so daily hand use is often normal. Long-term effects vary widely when leukonychia totalis is part of a broader inherited condition, because other body systems may also be involved.
The white color usually affects most or all fingernails and toenails for the long term, and it may remain stable throughout life. This means the nails often keep the same pale, opaque look rather than returning to their usual pink tone.
In many living with leukonychia totalis, nail growth and basic nail strength are often normal despite the color change. The long-term picture is often more cosmetic than disabling, with little effect on everyday tasks like buttoning clothes or typing.
Some people with leukonychia totalis feel self-conscious about how their nails look, especially in social settings or jobs where hands are very visible. Over time, daily routines may include extra attention to hiding or explaining the nail change.
When leukonychia totalis is part of a genetic syndrome, long-term effects can extend beyond the nails and may include changes in hearing, skin, hair, or other organs. This is one reason doctors may look beyond the nails, especially if the early symptoms of leukonychia totalis appear alongside other unusual features.
How is it to live with Leukonychia totalis?
Living with leukonychia totalis usually means having nails that look completely white all the time, often from early life, while the nails themselves are otherwise normal and painless. For most people, daily life is affected far more by appearance and questions from others than by physical symptoms, since this condition usually does not limit walking, working, writing, sports, or other routine activities. Some may feel self-conscious in social settings or spend time explaining that the nail color is a benign trait rather than an infection or a sign of poor health. For family members and close friends, the main impact is often reassurance and understanding, especially if the white nails run in the family or if extra medical checks are needed to rule out an associated condition in some cases.
Treatment and drugs
Leukonychia totalis means the nails look white from base to tip, and treatment mostly depends on why it is happening. If leukonychia totalis is inherited, there is usually no medicine that turns the nails back to their usual color, but the condition is often harmless and care focuses on checking for any related skin, hearing, or other health issues if they are present. If it is acquired later in life, doctors look for and treat the underlying cause, which may include a nutritional problem, another medical condition, or a reaction to a medication or chemical exposure. Supportive care can make a real difference in how you feel day to day, and this may include protecting the nails from repeated trauma, avoiding harsh nail products, and treating any nail infection if one is found. If you notice early symptoms of leukonychia totalis or a sudden change in several nails at once, it is worth seeing a doctor so the cause can be checked rather than assuming it is only cosmetic.
Can you cure Leukonychia totalis?
There is no direct cure for leukonychia totalis, especially if someone is born with it. If the nails turn white because of another health problem or a medicine, treating that cause may help the nails improve over time. For many living with leukonychia totalis, care is mainly about checking for a treatable cause and keeping the nails healthy and protected.
Non-drug treatment
Leukonychia totalis usually affects nail appearance more than day-to-day health, so non-drug care is mostly about protecting the nails and checking whether something else is contributing. Many people living with leukonychia totalis do not need active treatment if it is inherited and there are no other symptoms. Managing this condition often means gentle nail care, avoiding repeated damage, and seeing a clinician if the nail change is new or comes with other health concerns. In acquired cases, care also focuses on finding and addressing the cause of suddenly white nails.
Keeping nails trimmed, clean, and dry can help prevent splitting and breakage. Gentle filing and avoiding picking or scraping under the nails may reduce everyday trauma.
Repeated pressure from biting, aggressive manicures, or tight shoes can stress the nail unit. Some strategies can slip naturally into your routine—like using proper footwear and being careful with nail grooming.
Harsh nail products, frequent polish removers, and cleaning chemicals can irritate nails and surrounding skin. Wearing gloves for wet work and choosing milder nail products may help protect fragile nails.
Regular moisturizer on the nails and cuticles can reduce dryness and brittleness. This will not turn white nails back to pink, but it can improve comfort and nail strength.
Your genes may have an impact on how drugs work for you
For people with leukonychia totalis, there usually is not a specific medicine used to treat the white nails themselves, so genetic differences do not often play a direct role in choosing a drug for this condition. What matters more is whether the nail change is part of another health problem, because treatment is aimed at that cause, and in those cases a person’s genes may sometimes affect how their body handles certain medicines. In other words, genetic testing is not a routine part of care for leukonychia totalis itself, but it can matter if there is an underlying condition that needs treatment.
Pharmacological treatments
For most people with Leukonychia totalis, there is no medicine that directly turns the nails back to their usual color. Treatment depends on why the nails became white in the first place, and many inherited cases do not need drug treatment at all. If Leukonychia totalis is acquired, doctors focus on treating the underlying cause rather than the nail color itself. Not everyone responds to the same medication in the same way.
There is no standard medication specifically approved to treat Leukonychia totalis itself. In many living with inherited Leukonychia totalis, the white nails are harmless and medicines are not needed.
If Leukonychia totalis happens because of another health problem, treatment is aimed at that condition. This may include medicines for liver, kidney, or nutritional problems when a doctor confirms they are contributing to the nail changes.
Some cases improve after stopping or changing a medicine that may be causing the nail whitening, but this should only be done with medical guidance. Never stop or change a prescription without checking with your healthcare provider.
If tests show a true mineral or vitamin deficiency, supplements such as zinc or iron may be recommended. This is only helpful when a deficiency is actually present, not as a routine treatment for the early symptoms of Leukonychia totalis.
Genetic influences
Leukonychia totalis can sometimes run in families, especially when the nails have been white since birth or early childhood. It’s natural to ask whether family history plays a role. In some families, inherited leukonychia totalis is linked to changes in a gene called PLCD1, and it is often passed down in an autosomal dominant pattern, which means a child may inherit it if one parent carries the gene change.
Not all leukonychia totalis is genetic, though, so a family history is not always present. Rarely, white nails can be one feature of a broader inherited condition, especially if there are also skin, hair, hearing, or growth differences. When doctors are working out what causes leukonychia totalis in families, they look at when it started, whether other relatives are affected, and whether other body systems are involved.
Is Leukonychia totalis genetic?
Genetics can be very important in leukonychia totalis, especially when it runs in families from birth or early childhood. Some inherited gene changes can cause leukonychia totalis on their own or as part of a broader syndrome, while others develop it without a clear genetic cause.
Having a genetic risk is not necessarily a diagnosis
Genetic variants are a usual part of human biology and are widespread in the general population. Most do not have a direct impact on health and are simply part of natural human diversity. For many genes, carrying a variant associated with a condition suggests a possible link rather than a definite diagnosis, especially when several genes and environmental factors play a role. In some cases, though, a single well-characterized variant in a specific gene is enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
If all of the nails stay white and keep growing in that way, treatment usually depends more on why leukonychia totalis is happening than on the nail color alone. When leukonychia totalis is inherited, the gene change is often the main reason for the nail finding, and there is usually no medicine that can restore a typical nail color. Instead, doctors focus on confirming whether it is an isolated trait or part of a broader inherited condition, because that can affect what other health checks or treatments are needed. Genetics is only one factor, and doctors also look for causes that are not inherited, such as injury, nutritional problems, infections, or other illnesses, since those may improve when the underlying problem is treated. For many living with leukonychia totalis, this means treatment for inherited leukonychia totalis is often different from treatment for nail whitening that started later from another cause. At this time, pharmacogenetic testing is not a routine part of treating leukonychia totalis itself, because there is no standard drug treatment for the nail color change alone.
Interactions with other conditions
Seeing all of the nails turn white can be unsettling, and for many people with leukonychia totalis, the key question is whether it is just a nail finding or a sign of something broader. Leukonychia totalis does not usually harm the body by itself, but it can sometimes appear alongside other conditions, especially inherited skin disorders, hearing loss, or changes in the hair and thickened skin on the palms and soles. To understand overall health, it’s useful to see how conditions overlap. In some people, especially when leukonychia totalis starts in childhood or runs in the family, doctors may look for a syndrome that links the nail changes with other features rather than treating the nails as a separate problem. When leukonychia totalis appears later in life, it may prompt a check for underlying illness such as poor nutrition, low blood protein, liver disease, or other long-term medical problems, because the white nails can sometimes be a clue rather than the main issue. If you are wondering about the early symptoms of leukonychia totalis, it also helps to note whether there are other changes happening at the same time, such as hearing problems, skin thickening, hair changes, or signs of general illness, since that pattern can guide what testing is needed.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Leukonychia totalis?
Completely white nails can also be caused by a fungal nail infection, repeated injury to the nails, or long-term skin conditions such as psoriasis that affect the nails. Sometimes the nails only look white because of changes in the tissue underneath them rather than in the nail itself, which can happen with serious health problems such as liver disease, kidney disease, heart failure, or very low protein levels.
History
Long before nail disorders were sorted into modern categories, doctors and families had noticed that some people had nails that looked milky white from edge to edge. In everyday life, this could mean a child or adult had strikingly pale fingernails and toenails even though the nails were not always painful or fragile. Over time, these observations helped separate lifelong nail whitening from the more common white spots or color changes that can happen after injury, infection, or other illnesses.
Leukonychia totalis is the medical name for complete whitening of the nails, and older medical writing gradually began to describe it as a distinct pattern rather than a cosmetic curiosity. Early reports were limited because doctors mainly had the nail’s appearance to go by, and they did not yet have today’s tools for studying skin, nails, and inherited conditions. That meant some cases were grouped together even though they likely had different causes.
As medical science evolved, physicians became better at telling apart true changes within the nail plate from whitening caused by changes under the nail. That step mattered because it showed that not all “white nails” are the same condition. It also helped doctors recognize that leukonychia totalis can appear on its own in some families, while in other people it may be part of a broader medical picture.
By the late 20th century and into more recent decades, case reports and family studies gave a clearer picture of how leukonychia totalis can show up across generations or appear alongside other nail findings. Researchers later identified that some forms have a genetic cause, which helped confirm what careful observation had suggested for years. At the same time, doctors also learned to stay alert for non-genetic causes of white nails, especially when the change starts later in life or comes with other symptoms.
Today, the history of leukonychia totalis is less about one dramatic discovery and more about steady refinement. What once may have been dismissed as an unusual nail appearance is now understood as a recognizable condition with different possible explanations. Knowing this history helps explain why the evaluation still starts with simple questions: when the white color began, whether other family members have it, and whether there are any other health changes alongside the nails.