bright white streak up the center of my right big toenail

by Carol
(Colmesneil, Tx)

Painful bright white streak up the center of my big toe on my right big toe nail bed... Is this from psoriasis? Is thjis a fungal infection? or is this something serious? It is not going away and is concerning me.

RESPONSE
Hi Carol,
The fact that the toe hurts is good news because hopefully that will encourage you to seek the services of a foot specialist or a dermatologist. I would have to actually examine your toe to give you a definitive diagnosis but I can discuss some of the possibilities.
If you have a history of psoriasis then yes there is a possibility that it is a psoriatic nail which although may be painful is not potentially dangerous. The psoriatic nail in worst case scenario could worsen but overall is a benign condition.
Another possibility is that of a fungus nail. Like a psoriatic nail, a fungus nail is also a benign condition. The fungus grows under the nail and lifts the nail off the nail bed causing the discoloration. The problem with fungus nails is that the nail itself, over time, will probably worsen and in many cases may spread to the other nails.
Another possibility is that of a growth on the nail bed. When there is an abnormality on the nail bed, it will adversely affect the part of the nail that is growing over it, so if the growth is located in the back of the nail then the white streak will continue.
Trauma to the nail may also cause this type of white streak. The trauma does not have to be overt direct trauma like dropping a can of soup on your toe. It can be micro type trauma. An example would be someone who keeps their nails too long. They then get a backward jamming of the nail and this may cause enough trauma for the nail to become deformed.
The last possibility although rare is that of a melanoma. More specifically what is known as an amelanotic melanoma. This is a melanoma that is white in color so they can be easily mistaken.
Typically what happens is that the growth begins near the growth plate of the nail. It then distorts the nail in that one location and as new nail continues to growth from that spot, it grows forward as a white streak.
As I said earlier, I have no idea as to what is actually causing the discoloration, but I think the smart money would be to have a specialist look at the nail and then get an accurate diagnosis and some appropriate treatment.

Marc Mitnick DPM
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