Muehrcke Lines of the Fingernails Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 9, 2011
 

Laboratory Studies

Obtain appropriate laboratory tests as indicated by the history features and the physical examination findings. The most important test is probably serum albumin measurements. Total serum protein levels, serum chemistry enzyme levels, a urine analysis, and a CBC count are also useful tests. In patients being treated for cancer, obtaining the blood levels of certain chemotherapeutic agents is probably important.

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Procedures

Certain studies, including nail composition studies; potassium hydroxide preparations; or biopsy with light microscope, electron microscope, or special staining, may be indicated.

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Histologic Findings

According to Nabai, histopathologic sections of the nail plates show compact orthokeratotic keratinous material in combination with areas suggesting some delay in keratinization. No definite evidence of parakeratotic change is present, and no evidence of distortion or thinning of the nail plates exists.[9] James and Odom[24] additionally suggested that the injury may lead to the development of parakeratotic or dyskeratotic foci within the nail matrix and retained in the nail plate; however, they were unable to show such histologic changes in their patient.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and 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

Richard K Scher, MD  Professor of Dermatology, University of North Carolina

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

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

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

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

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

Disclosure: Nothing to disclose.

References

  1. Muehrcke RC. The finger-nails in chronic hypoalbuminaemia; a new physical sign. Br Med J. Jun 9 1956;1(4979):1327-8. [Medline].

  2. Schwartz RA, Vickerman CE. Muehrcke's lines of the fingernails. Arch Intern Med. Feb 1979;139(2):242. [Medline].

  3. Brownson WC. An unusual condition of the nails in pellagra. South Med J. 1915;8:672-5.

  4. Shahani RT, Blackburn EK. Nail anomalies in Hodgkin's disease. Br J Dermatol. Nov 1973;89(5):457-8. [Medline].

  5. Hudson JB, Dennis AJ Jr. Transverse white lines in the fingernails after acute and chronic renal failure. Arch Intern Med. Feb 1966;117(2):276-9. [Medline].

  6. Samman PD, Johnston EN. Nail damage associated with handling of paraquat and diquat. Br Med J. Mar 29 1969;1(5647):818-9. [Medline].

  7. Daniel CR, Sams WM, Scher RK. Nails in systemic disease. In: Nails: Therapy, Diagnosis, Surgery. 2nd ed. Amsterdam: Elsevier Health Sciences; 1997:219-50.

  8. Conn RD, Smith RH. Malnutrition, myoedema, and Muehrcke's lines. Arch Intern Med. Dec 1965;116(6):875-8. [Medline].

  9. Nabai H. Nail changes before and after heart transplantation: personal observation by a physician. Cutis. Jan 1998;61(1):31-2. [Medline].

  10. Morris D, Aisner J, Wiernik PH. Horizontal pigmented banding of the nails in association with adriamycin chemotherapy. Cancer Treat Rep. May-Jun 1977;61(3):499-501. [Medline].

  11. Pratt CB, Shanks EC. Letter: Hyperpigmentation of nails from doxorubicin. JAMA. Apr 22 1974;228(4):460. [Medline].

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  14. 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. Dec 1972;77(6):861-70. [Medline].

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  16. Goldman L, Blaney DJ, Cohen W. Onychodystrophy after topical 5-fluorouracil. Arch Dermatol. Nov 1963;88:529-30. [Medline].

  17. Katz ME, Hansen TW. Nail plate-nail bed separation. An unusual side effect of systemic fluorouracil administration. Arch Dermatol. Jul 1979;115(7):860-1. [Medline].

  18. Shelley WB. Onycholysis due to topical 5-fluorouracil. Acta Derm Venereol. 1972;52(4):320-2. [Medline].

  19. Harrison BM, Wood CB. Cyclophosphamide and pigmentation. Br Med J. May 6 1972;2(5809):352. [Medline].

  20. Shah PC, Rao KR, Patel AR. Letter: Cyclophosphamide-induced nail pigmentation. Lancet. Sep 20 1975;2(7934):548-9. [Medline].

  21. deMarinis M, Hendricks A, Stoltzner G. Nail pigmentation with daunorubicin therapy. Ann Intern Med. Oct 1978;89(4):516-7. [Medline].

  22. Victoroff VM. Transverse white lines in the fingernails induced by combination chemotherapy. Arch Dermatol. Sep 1993;129(9):1217-8. [Medline].

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  25. Modesto dos Santos V, Sugai TA, Cezar BF, Vasconcellos de Rezende AC. Transverse leukonychia: a case report. West Afr J Med. Apr-Jun 2005;24(2):181-2. [Medline].

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  27. Feldman SR, Gammon WR. Unilateral Muehrcke's lines following trauma. Arch Dermatol. Jan 1989;125(1):133-4. [Medline].

  28. Monteagudo B, Cabanillas M, Suarez-Amor O, Martinez-Calvo L, Grana-Suarez B. [Muehrcke's lines on nails after docetaxel/cisplatin/fluorouracil]. Gastroenterol Hepatol. May 2009;32(5):381-2. [Medline].

  29. Assadi F. Leukonychia associated with increased blood strontium level. Clin Pediatr (Phila). Jul-Aug 2005;44(6):531-3. [Medline].

  30. Dasanu CA, Wiernik PH, Vaillant J, Alexandrescu DT. A complex pattern of melanonychia and onycholysis after treatment with pemetrexed for lung cancer. Skinmed. Mar-Apr 2007;6(2):95-6. [Medline].

  31. Pucevich B, Spencer L, English JC 3rd. Unilateral trachyonychia in a patient with reflex sympathetic dystrophy. J Am Acad Dermatol. Feb 2008;58(2):320-2. [Medline].

  32. 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. Nov 2008;22(11):1326-31. [Medline].

  33. 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. Sep-Oct 2008;51(5):436-43. [Medline].

 
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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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