Differential Diagnosis for White Dots on Fingernails in a 14-Year-Old Male

Single Most Likely Diagnosis

• Leukonychia: This condition is characterized by the appearance of white spots or dots on the nails, often due to minor trauma to the nail bed, such as hitting the nail against a hard surface. It's very common in children and adolescents.

Other Likely Diagnoses

• Nail Trauma: Direct injury to the nail can cause white spots due to the formation of keratin deposits under the nail plate.
• Fungal Infections: While less common, fungal infections like onychomycosis can cause changes in nail color, including white spots, especially if the infection is superficial.
• Nutritional Deficiencies: Deficiencies in vitamins like B7 (biotin) or minerals can affect nail health, leading to changes such as white spots.

Do Not Miss Diagnoses

• Systemic Lupus Erythematosus (SLE): Although rare, SLE can cause a variety of nail changes, including white spots, as part of its broader spectrum of symptoms. Missing this diagnosis could have significant implications for the patient's health.
• Terry's Nails: Associated with liver disease, these nails can appear white due to a decrease in the nail bed vascularity, and it's crucial not to overlook underlying liver conditions.

Rare Diagnoses

• Darier's Disease: A rare genetic disorder that affects the skin and sometimes the nails, causing white or pinkish lesions.
• Sarcoidosis: A condition that can affect multiple parts of the body, including the skin and nails, causing a variety of nail changes, including white spots, due to granulomatous infiltration.