Muehrcke Lines of the Fingernails Differential Diagnoses

Updated: May 23, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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DDx

Diagnostic Considerations

Also consider the following:

  • Leukonychia
  • Beau lines
  • Mees lines
  • Erythematous crescent
  • Terry nails
  • Half-and-half fingernail
  • Splinter hemorrhages
  • Leukonychia associated with increased blood strontium level [35]
  • Melanonychia with onycholysis [36]
  • Onychopapilloma: This benign nail bed neoplasm may be associated with leukonychia. [37]
  • Reflex Sympathetic Dystrophy: This may be associated with changes including unilateral leukonychia, Beau lines, nailfold swelling, nail clubbing, and unilateral atypical trachyonychia. [38]

Nails of 100 patients with chronic renal failure under regular hemodialysis were compared with 100 healthy control subjects of matched age and sex. [39] Of these patients, 76% had nail findings, with half and half nails the most common at 20%, followed by—in descending manner—absent lunula, onycholysis, brittle nail, Beau lines, clubbing, longitudinal ridging, onychomycosis, subungual hyperkeratosis, koilonychias, total leukonychia, splinter hemorrhage, pitting, and pincer nail deformity.

Various types of leukonychia may be considered, including leukonychia punctata, leukonychia striata, leukonychia partialis, and leukonychia totalis. [40, 41, 42] “ True” leukonychia involves the nail plate and “apparent” leukonychia derives from the nail bed. [43] Familial leukonychia may rarely be associated with sebaceous cysts, apparently an autosomal dominant genetic disorder. [44] True acquired leukonychia may be associated with trauma, chemotherapeutic agents, hypocalcemia, zinc deficiency, heavy metal poisoning, local infection, and systemic diseases. [45] Selenium deficiency has also been suggested as a possible etiology. [43]

Loss-of-function mutations in calpastatin may produce a syndrome of generalized peeling skin, leukonychia, acral punctate keratoses, cheilitis, and knuckle pads. [46]

Differential Diagnoses