Muehrcke Lines of the Fingernails Treatment & Management
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
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 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.
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. Large amounts of multivitamin injections did not have any effect on the appearance of the white bands in the fingernails of patients.
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.
Muehrcke RC. The finger-nails in chronic hypoalbuminaemia; a new physical sign. Br Med J. 1956 Jun 9. 1(4979):1327-8. [Medline].
Schwartz RA, Vickerman CE. Muehrcke's lines of the fingernails. Arch Intern Med. 1979 Feb. 139(2):242. [Medline].
Lipner SR, Scher RK. Evaluation of nail lines: Color and shape hold clues. Cleve Clin J Med. 2016 May. 83 (5):385-91. [Medline].
Brownson WC. An unusual condition of the nails in pellagra. South Med J. 1915. 8:672-5.
Shahani RT, Blackburn EK. Nail anomalies in Hodgkin's disease. Br J Dermatol. 1973 Nov. 89(5):457-8. [Medline].
Hudson JB, Dennis AJ Jr. Transverse white lines in the fingernails after acute and chronic renal failure. Arch Intern Med. 1966 Feb. 117(2):276-9. [Medline].
Samman PD, Johnston EN. Nail damage associated with handling of paraquat and diquat. Br Med J. 1969 Mar 29. 1(5647):818-9. [Medline].
Daniel CR, Sams WM, Scher RK. Nails in systemic disease. Nails: Therapy, Diagnosis, Surgery. 2nd ed. Amsterdam: Elsevier Health Sciences; 1997. 219-50.
Conn RD, Smith RH. Malnutrition, myoedema, and Muehrcke's lines. Arch Intern Med. 1965 Dec. 116(6):875-8. [Medline].
Nabai H. Nail changes before and after heart transplantation: personal observation by a physician. Cutis. 1998 Jan. 61(1):31-2. [Medline].
Morris D, Aisner J, Wiernik PH. Horizontal pigmented banding of the nails in association with adriamycin chemotherapy. Cancer Treat Rep. 1977 May-Jun. 61(3):499-501. [Medline].
Pratt CB, Shanks EC. Letter: Hyperpigmentation of nails from doxorubicin. JAMA. 1974 Apr 22. 228(4):460. [Medline].
Priestman TJ, James KW. Letter: Adriamycin and longitudinal pigmented banding of fingernails. Lancet. 1975 Jun 14. 1(7920):1337-8. [Medline].
Shetty MR. Case of pigmented banding of the nail caused by bleomycin. Cancer Treat Rep. 1977 May-Jun. 61(3):501-2. [Medline].
Yagoda A, Mukherji B, Young C, Etcubanas E, Lamonte C, Smith JR, et al. Bleomycin, an antitumor antibiotic. Clinical experience in 274 patients. Ann Intern Med. 1972 Dec. 77(6):861-70. [Medline].
Falkson G, Schultz EJ. Skin changes in patients treated with 5-fluorouracil. Br J Dermatol. 1962 Jun. 74:229-36. [Medline].
Goldman L, Blaney DJ, Cohen W. Onychodystrophy after topical 5-fluorouracil. Arch Dermatol. 1963 Nov. 88:529-30. [Medline].
Katz ME, Hansen TW. Nail plate-nail bed separation. An unusual side effect of systemic fluorouracil administration. Arch Dermatol. 1979 Jul. 115(7):860-1. [Medline].
Shelley WB. Onycholysis due to topical 5-fluorouracil. Acta Derm Venereol. 1972. 52(4):320-2. [Medline].
Harrison BM, Wood CB. Cyclophosphamide and pigmentation. Br Med J. 1972 May 6. 2(5809):352. [Medline].
Shah PC, Rao KR, Patel AR. Letter: Cyclophosphamide-induced nail pigmentation. Lancet. 1975 Sep 20. 2(7934):548-9. [Medline].
deMarinis M, Hendricks A, Stoltzner G. Nail pigmentation with daunorubicin therapy. Ann Intern Med. 1978 Oct. 89(4):516-7. [Medline].
Victoroff VM. Transverse white lines in the fingernails induced by combination chemotherapy. Arch Dermatol. 1993 Sep. 129(9):1217-8. [Medline].
Nixon DW. Alterations in nail pigment with cancer chmotherapy. Arch Intern Med. 1976 Oct. 136(10):1117-8. [Medline].
James WD, Odom RB. Chemotherapy-induced transverse white lines in the fingernails. Arch Dermatol. 1983 Apr. 119(4):334-5. [Medline].
Modesto dos Santos V, Sugai TA, Cezar BF, Vasconcellos de Rezende AC. Transverse leukonychia: a case report. West Afr J Med. 2005 Apr-Jun. 24(2):181-2. [Medline].
Robert C, Sibaud V, Mateus C, Verschoore M, Charles C, Lanoy E, et al. Nail toxicities induced by systemic anticancer treatments. Lancet Oncol. 2015 Apr. 16 (4):e181-9. [Medline].
Daniel CR 3rd, Osment LS. Nail pigmentation abnormalities. Their importance and proper examination. Cutis. 1980 Jun. 25(6):595-607. [Medline].
Feldman SR, Gammon WR. Unilateral Muehrcke's lines following trauma. Arch Dermatol. 1989 Jan. 125(1):133-4. [Medline].
Monteagudo B, Cabanillas M, Suarez-Amor O, Martinez-Calvo L, Grana-Suarez B. [Muehrcke's lines on nails after docetaxel/cisplatin/fluorouracil]. Gastroenterol Hepatol. 2009 May. 32(5):381-2. [Medline].
Chávez-López MA, Arce-Martínez FJ, Tello-Esparza A. Muehrcke lines associated to active rheumatoid arthritis. J Clin Rheumatol. 2013 Jan. 19(1):30-1. [Medline].
Assadi F. Leukonychia associated with increased blood strontium level. Clin Pediatr (Phila). 2005 Jul-Aug. 44(6):531-3. [Medline].
Dasanu CA, Wiernik PH, Vaillant J, Alexandrescu DT. A complex pattern of melanonychia and onycholysis after treatment with pemetrexed for lung cancer. Skinmed. 2007 Mar-Apr. 6(2):95-6. [Medline].
Tosti A, Schneider SL, Ramirez-Quizon MN, Zaiac M, Miteva M. Clinical, dermoscopic, and pathologic features of onychopapilloma: A review of 47 cases. J Am Acad Dermatol. 2016 Mar. 74 (3):521-6. [Medline].
Pucevich B, Spencer L, English JC 3rd. Unilateral trachyonychia in a patient with reflex sympathetic dystrophy. J Am Acad Dermatol. 2008 Feb. 58(2):320-2. [Medline].
Salem A, Al Mokadem S, Attwa E, Abd El Raoof S, Ebrahim HM, Faheem KT. Nail changes in chronic renal failure patients under haemodialysis. J Eur Acad Dermatol Venereol. 2008 Nov. 22(11):1326-31. [Medline].
Arsiwala SZ. Idiopathic acquired persistent true partial to total leukonychia. Indian J Dermatol Venereol Leprol. 2012 Jan. 78(1):107-8. [Medline].
Farooq M, Kurban M, Abbas O, et al. A novel mutation in the PLCD1 gene, which leads to an aberrant splicing event, underlies autosomal recessive leukonychia. Br J Dermatol. 2012 Mar 28. [Medline].
Clayton N, Atkar R, Verdolini R. Ten bright-white fingernails in two young healthy patients. Congenital total (patient 1) and subtotal (patient 2) leuconychia (white nails syndrome, or milky nails). Clin Exp Dermatol. 2012 Mar. 37(2):201-2. [Medline].
Hasunuma N, Umebayashi Y, Manabe M. True leukonychia in Crohn disease induced by selenium deficiency. JAMA Dermatol. 2014 Jul. 150(7):779-80. [Medline].
Morin G, Desenclos C, Jeanpetit C, Lévy N, Deramond H, Mathieu M. Additional familial case of subtotal leukonychia and sebaceous cysts (Bauer syndrome): belong the nervous tumours to the phenotype?. Eur J Med Genet. 2008 Sep-Oct. 51(5):436-43. [Medline].
Lin Z, Zhao J, Nitoiu D, Scott CA, Plagnol V, Smith FJ, et al. Loss-of-function mutations in CAST cause peeling skin, leukonychia, acral punctate keratoses, cheilitis, and knuckle pads. Am J Hum Genet. 2015 Mar 5. 96 (3):440-7. [Medline].