Muehrcke Lines of the Fingernails Treatment & Management

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

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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