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 ^[37]
Melanonychia with onycholysis ^[38]
Onychopapilloma: This benign nail bed neoplasm may be associated with leukonychia. ^[39]
Reflex Sympathetic Dystrophy: This may be associated with changes including unilateral leukonychia, Beau lines, nailfold swelling, nail clubbing, and unilateral atypical trachyonychia. ^[40]

Nails of 100 patients with chronic renal failure under regular hemodialysis were compared with 100 healthy control subjects of matched age and sex.^[41]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.^{[42, 43, 44]}“ True” leukonychia involves the nail plate and “apparent” leukonychia derives from the nail bed.^[45]Familial leukonychia may rarely be associated with sebaceous cysts, apparently an autosomal dominant genetic disorder.^[46]True acquired leukonychia may be associated with trauma, chemotherapeutic agents, hypocalcemia, zinc deficiency, heavy metal poisoning, local infection, and systemic diseases.^[47]Selenium deficiency has also been suggested as a possible etiology.^[45]

Loss-of-function mutations in calpastatin may produce a syndrome of generalized peeling skin, leukonychia, acral punctate keratoses, cheilitis, and knuckle pads.^[48]

Differential Diagnoses

Workup

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Media Gallery

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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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

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, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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.

Sections Muehrcke Lines of the Fingernails
Overview
Presentation
DDx
Workup
Treatment
Media Gallery
References

Muehrcke Lines of the Fingernails Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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