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Muehrcke Lines of the Fingernails Treatment & Management

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 22, 2016
 

Medical Care

Treatment should be undertaken in a case-specific manner. In patients presenting with paired, white, transverse lines due to a serum albumin deficiency, albumin infusions to raise the serum level aid in the disappearance of Muehrcke lines. Treatment of the underlying disease additionally aids in correcting the abnormal serum albumin levels.

Muehrcke[1] reported on the effects of intravenous albumin, cortisone, and corticotrophin therapy on the white bands. A 44-year-old engineer with amyloid disease presented with gross proteinuria, white bands on all the fingernails (except the thumb), and a serum albumin level of 1.9 g/100 mL. Over the course of 3 weeks, he was given a total of 750 g of albumin, resulting in a transitory increase in the serum albumin level. After 3 weeks of the albumin infusion, the white bands almost completely disappeared. However, 3 months later, the serum albumin level decreased again, and the bands reappeared.

In a similar fashion, a patient with nephrotic syndrome due to subacute membranous glomerulonephritis received an infusion of 750 g of albumin, which increased his serum level from 2.2 g/100 mL to 3.4 g/100 mL. As a result, the white bands became progressively less visible. Once the serum albumin level returned to the reference range, the white bands fully disappeared.[1]

A third patient with nephrotic syndrome, with a serum albumin level of 1.6 g/100 mL, and with prominent white bands was treated with cortisone therapy over 3 months. At the end of the 3-month period, her serum albumin level increased to 2.9 g/100 mL, and the white bands disappeared.

A 14-year-old boy with anasarca, with a serum albumin level of 1.5 g/100 mL, and with white fingernail bands received 10 days of corticotrophin therapy, followed by a cortisone maintenance treatment. Over the course of several months, his albumin level increased to 3.7 g/100 mL, and the white bands disappeared.[1] Large amounts of multivitamin injections did not have any effect on the appearance of the white bands in the fingernails of patients.[1]

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Long-Term Monitoring

Muehrcke lines may be associated with hypoalbuminemia; therefore, patients presenting with the paired, white, transverse bands should be evaluated for certain possible causes. As mentioned earlier, these causes include liver disease, malnutrition, nephrotic syndrome, and glomerulonephritis.

Paired, white, transverse lines are also associated with chemotherapeutic agents. Therefore, other drug options or different treatment regimens should be considered in patients who develop Muehrcke lines while undergoing treatment for cancer.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Channing R Barnett, MD Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey

Channing R Barnett, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina at Chapel Hill School of Medicine; Professor Emeritus of Dermatology, Columbia University College of Physicians and Surgeons

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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White, transverse, horizontal lines are observed on 4 fingers of a 49-year-old man with adenocarcinoma in his rectosigmoid and adenoma in his sigmoid found in May 2002; he was treated with preoperative radiation and 4 continuous infusions of 5-fluorouracil at the same time.
Close-up view.
White transverse bands are seen on all 10 fingers.
Horizontal white bands are seen on all 10 fingernails.
Close-up view of 4 fingers. White horizontal bands are evident.
Close-up view. White horizontal bands are evident.
 
 
 
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