What is Muehrcke Lines of the Fingernails?
Muehrcke’s nails, sometimes called Muehrcke’s lines, were first explained by Dr. Robert Muehrcke in a 1956 article in the British Medical Journal. These are characterized by a white color change in the nails, which goes away when pressure is applied, while the nail remains clear. Like other conditions that show a similar change in nail color, Muehrcke’s nails can suggest the presence of underlying health problems.
In Dr. Muehrcke’s original study of 65 patients, he found that this nail condition was often linked to a low level of protein in the blood, scientifically known as hypoalbuminemia. However, since that time, Muehrcke’s nails has also been connected to various other causes.
What Causes Muehrcke Lines of the Fingernails?
Muehrcke’s nails, a condition that affects the nails, can be caused by a lack of a protein called albumin in the body or hypoalbuminemia. Several health issues can trigger this lack of albumin, including nephrotic syndrome (a kidney disorder that causes your body to excrete too much protein in your urine), glomerulonephritis (another type of kidney disease), diseases that affect the liver, and malnutrition (not getting enough nutrients). In fact, the most common cause reported by Dr. Robert C. Muehrcke, who the condition is named after, is nephrotic syndrome.
Other things that can cause Muehrcke’s nails include periods of extreme metabolic stress (for example, widespread infections, AIDS). Physical injury can also lead to the development of this condition. In addition, it’s been observed in people who have undergone chemotherapy and those who climb mountains, likely due to the high physical stress they endure.
Risk Factors and Frequency for Muehrcke Lines of the Fingernails
Muehrcke’s nails is a condition that we don’t know much about in terms of how often it occurs. In fact, it’s considered pretty rare. To understand this, consider that a look through the medical literature database PubMed found just 27 publications that mention it. But, we think it could be going under the radar because it’s often linked with other health problems. So, people might be seeing their doctors for their other issues and these medical professionals might not know about, or look for, Muehrcke’s nails. While this condition can affect kids, most cases are in adults.
Signs and Symptoms of Muehrcke Lines of the Fingernails
Muehrcke’s nails is a condition that shows distinctive white bands running parallel to the base of the nail. Known causes of Muehrcke’s nails can vary, so a thorough medical history of the patient is important. This history should include information about any existing medical conditions, exposure to certain environments, the medicines the patient is taking, and their occupation. It’s also crucial to understand when the nail changes first appeared. This condition is usually harmless, but some systemic cancer treatments, such as taxanes or EGFR inhibitors, could cause changes in the nails, pain, and even impact your ability to perform certain functions.
- Detailed patient history for potential causes
- Understand when nail changes appeared
In a physical examination, these white bands, which are the same color as the lunula (the half-moon at the base of your nail), are set apart by the normal pink of the nail bed. The only key difference between these bands and the rest of the nail is their color; the bands don’t feel any different. Usually, Muehrcke’s nails appear on the second, third, and fourth fingers, while the thumb is rarely affected. The white lines will go away when you press on them, hence why they are termed ‘apparent’ leukonychia. Some patients undergoing chemotherapy might also display melanonychia, which means brown or black bands on the nails.
- Examine the color and feel of the white bands.
- Check for Muehrcke’s nails on the second, third, and fourth fingers as the thumb is rarely affected.
- Press the nails to see if the white lines disappear.
- Look for melanonychia in patients undergoing chemotherapy.
Testing for Muehrcke Lines of the Fingernails
The diagnosis for this particular condition primarily relies on a detailed medical history and a physical examination. This condition affects the small blood vessels in the nail bed, so it’s not advisable to take a sample (known as a biopsy) from the nail. Whether further lab tests are needed will depend on your personal medical history.
Several factors can cause this condition, so to pinpoint the cause, your doctor may ask for a blood test to measure your serum albumin level. Albumin is a protein made by your liver, and if it’s less than 2.2 g/100 mL, it might be related to this condition. Other tests that help to detect malnutrition might also be performed. These tests can include total protein count in your blood, a series of tests called serum chemistries that look, among other things, at electrolyte balance and kidney function, a complete blood count (which measures different types of cells in your blood), and urinalysis (testing your urine).
If you are undergoing chemotherapy, your doctor may want to check the level of the medication in your blood to see if there are any toxicity concerns. Imaging studies or scans are not necessary for diagnosing this condition.
Treatment Options for Muehrcke Lines of the Fingernails
Muehrcke’s nails is a condition that shows up as white lines on your nails. Its treatment will often depend on your specific circumstances. For instance, if this condition is due to low levels of albumin (a key protein your body needs), it can be treated by infusing this protein into your body. The aim is to ensure your albumin levels return to a normal range.
Also, it’s crucial to mention that treating the underlying causes of Muehrcke’s nails could play a significant role in restoring your albumin levels to normal. Therefore, addressing these root causes increases the chances of successfully managing the condition and fading these white lines. In some cases, doctors may recommend using therapies such as cortisone (a steroid medication) or corticotropin (a hormone used to treat various conditions) along with albumin infusions.
What else can Muehrcke Lines of the Fingernails be?
When doctors are diagnosing Muehrcke’s nails, they also consider several conditions that have similar symptoms. These include:
- Beau’s lines: These are noticeable and touchable deep grooves that go from side-to-side on the fingernail or toenail. This happens because of a temporary pause in nail growth due to things like infection or trauma.
- Mees’ lines: Also known as Aldrich or Reynolds’ lines, these are white, non-fading bands that run in a line with the lunula (the white half-moon shape) on your nail. They occur due to a disturbance at the end of the nail matrix, causing a condition of the ventral nail plate called parakeratosis. These lines are often found in cases of arsenic poisoning, metal toxicity, heart failure, and some infections.
- Terry’s nails: In this condition, most of the nail turns white (obscuring the lunula) and has a ground glass appearance. This happens because of reduced blood flow and an increase in tissue in the nail bed. While they were first correlated with liver cirrhosis, Terry’s nails are now seen in up to 25% of patients who are in hospital for any reason.
It’s important the doctor takes these possibilities into account and conducts appropriate tests to make an accurate diagnosis.
What to expect with Muehrcke Lines of the Fingernails
Muehrcke’s nails, a condition that affects the nails, does not itself give any indication of how a patient will recover. Instead, the patient’s path to recovery will depend on the root cause of this nail condition. As originally suggested by Muehrcke, if the underlying medical condition (such as hypoalbuminemia, which is a low level of albumin – a protein – in the blood) is treated, the lines on the nails synonymous with Muehrcke’s nails can often vanish.
Possible Complications When Diagnosed with Muehrcke Lines of the Fingernails
Muehrcke’s nails do not directly cause further complications, but they are instead a sign of an existing health issue. If chemotherapy or injury has caused Muehrcke’s nails, it’s possible for patients to experience pain and a reduction in their ability to perform daily tasks. This can increase discomfort and general illness. In cases where patients are undergoing chemotherapy for cancer, their functionality might be affected, making it important to address any concerns related to pain from Muehrcke’s nails. Furthermore, some patients may be self-conscious about the appearance of their nails. If so, it’s crucial to address the potential emotional stress this condition can cause, and build a supportive partnership to manage these concerns, mainly by treating the initial health issue.
Common Concerns in Patients with Muehrcke’s Nails:
- Pain and discomfort
- Limited physical functionality
- Self-consciousness about nail appearance
- Psychological stress related to the condition
Preventing Muehrcke Lines of the Fingernails
Maintaining a balanced diet and properly managing any existing medical conditions can help prevent Muehrcke’s nails. It’s key to understand a few things about this condition to alleviate unnecessary worry. First, Muehrcke’s nails primarily affect the appearance of your nails and are not a serious health issue. Second, knowing that this condition can often get better when the underlying cause is treated can be reassuring.
If there isn’t a known underlying condition when you’re diagnosed with Muehrcke’s nails, don’t panic. Your doctor will explain that more tests may need to be carried out to find the root cause. This is because Muehrcke’s nails are usually linked to another health condition that may not have been discovered yet. It’s important to understand this connection to ensure proper treatment and management.
