Unilateral Transverse Leukonychia in a Patient Receiving Isotretinoin Treatment with Concomitant Renal Impairment: A Case Report

Leukonychia is a white discoloration of nails. Although it is usually clinically insignificant, it can serve as a clue for systemic diseases that is sometimes life-threatening.

A 24-year-old male patient, with resistant acne vulgaris not responding to topicals nor systemic antibiotics and with a history of renal impairment and untreated recurrent high blood pressure readings, was started on isotretinoin. Three months later, he presented with a unilateral true transverse leukonychia with a worsening renal impairment. The patient was started on antihypertensive medications. The patient was seen two months later with unilateral transverse leukonychia fading (moving distally).

Repeated laboratory tests showed slightly increased serum creatinine, improved but still high protein/creatinine ratio. The fading of leukonychia while continuing isotretinoin treatment and after starting antihypertensive medication that has a renal protective effect may indicate a renal-associated leukonychia.

This is probably the first reported unilateral leukonychia without identified local/unilateral causes.