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

Abstract

Aims: 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. Case Report: 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). Results: 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. Conclusion: This is probably the first reported unilateral leukonychia without identified local/unilateral causes.