Muehrcke's nails or Muehrcke's lines (apparent leukonychia striata) are changes in the fingernail that may be a sign of an underlying medical condition. The term refers to a set of one or more pale transverse bands extending all the way across the nail, parallel to the lunula. In contrast to Beau's lines, they are not grooved (no 3-dimensional deformity), and in contrast to Mees' lines, the thumb is usually not involved.[1][2]
Muehrcke's lines
Other names
Apparent leukonychia striata
Muehrcke's lines are a strong indicator of hypoalbuminemia, which can result from a variety of different causes.[3][4]
The lines are actually in the vascular bed underneath the nail plate. As such, they do not move with nail growth, and disappear when pressure is applied to the nail (blanching the underlying nail bed): this distinguishes them from "true leukonychia striata" such as Mees' lines.[1] As in Terry's and half-and-half nails, the pattern is thought to be formed by bands of localized edema exerting pressure on the surrounding capillaries.[3][5]
The lines remain visible as long as protein intake is inadequate or synthesis is impaired, and they should disappear upon return to normal function.[3]
In extreme conditions, Muehrcke's lines may also arise from physical changes in peripheral circulation: one case study reported appearance of the lines in a healthy subject following ascent to 8,848 meters (29,029 ft) on Mount Everest.[10]
Historyedit
Muehrcke's lines were described by American physician Robert C. Muehrcke (1921–2003) in 1956. In a study published in BMJ, he examined patients with known chronic hypoalbuminemia and healthy volunteers, finding that the appearance of multiple transverse white lines was a highly specific marker for low serum albumin (no subject with the sign had SA over 2.2 g/dL), was associated with severity of the underlying condition, and disappeared upon successful treatment (corticosteroids in nephrotic syndrome) or direct infusion of HSA.[4]
See alsoedit
Mees' lines – a similar appearance, except the lines are in the nail and move as the nail grows
^ abRapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN978-1-4160-2999-1.
^Zaiac, Martin N.; Walker, Ashley (September 2013). "Nail abnormalities associated with systemic pathologies". Clinics in Dermatology. 31 (5): 627–649. doi:10.1016/j.clindermatol.2013.06.018. ISSN 1879-1131. PMID 24079592.
^ abcdSingal, Archana; Arora, Rahul (2015). "Nail as a window of systemic diseases". Indian Dermatology Online Journal. 6 (2): 67–74. doi:10.4103/2229-5178.153002. ISSN 2229-5178. PMC4375768. PMID 25821724.
^ abMUEHRCKE RC (June 1956). "The finger-nails in chronic hypoalbuminaemia; a new physical sign". Br Med J. 1 (4979): 1327–8. doi:10.1136/bmj.1.4979.1327. PMC1980060. PMID 13316143.
^Hinds, Ginette; Thomas, Valencia D. (January 2008). "Malignancy and cancer treatment-related hair and nail changes". Dermatologic Clinics. 26 (1): 59–68, viii. doi:10.1016/j.det.2007.08.003. ISSN 0733-8635. PMID 18023771.
^Freedberg, Irwin M.; et al., eds. (2003). Fitzpatrick's dermatology in general medicine (6th ed.). New York, NY: McGraw-Hill. p. 659. ISBN978-0-07-138076-8.
^Bianchi L, Iraci S, Tomassoli M, Carrozzo AM, Nini G (1992). "Coexistence of apparent transverse leukonychia (Muehrcke's lines type) and longitudinal melanonychia after 5-fluorouracil/adriamycin/cyclophosphamide chemotherapy". Dermatology. 185 (3): 216–7. doi:10.1159/000247451. PMID 1446089.
^Chapman S, Cohen PR (April 1997). "Transverse leukonychia in patients receiving cancer chemotherapy". South. Med. J. 90 (4): 395–8. doi:10.1097/00007611-199704000-00006. PMID 9114829. S2CID 29031413.
^Morrison-Bryant M, Gradon JD (2007). "Muehrcke's Lines". N Engl J Med. 357 (9): 917. doi:10.1056/NEJMicm065055. PMID 17761595.
^Windsor, Jeremy S.; Hart, Nigel; Rodway, George W. (2009). "Muehrcke's Lines on Mt. Everest". High Altitude Medicine & Biology. 10 (1): 87–88. doi:10.1089/ham.2008.1079. ISSN 1557-8682. PMID 19278357.
Bibliographyedit
Fawcett, Robert S.; Sean Linford; Daniel L. Stulberg (March 15, 2004). "Nail Abnormalities: Clues to Systemic Disease". American Family Physician. 69 (6): 1417–24. PMID 15053406.
James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN0-7216-2921-0.
muehrcke, nails, muehrcke, lines, apparent, leukonychia, striata, changes, fingernail, that, sign, underlying, medical, condition, term, refers, more, pale, transverse, bands, extending, across, nail, parallel, lunula, contrast, beau, lines, they, grooved, dim. Muehrcke s nails or Muehrcke s lines apparent leukonychia striata are changes in the fingernail that may be a sign of an underlying medical condition The term refers to a set of one or more pale transverse bands extending all the way across the nail parallel to the lunula In contrast to Beau s lines they are not grooved no 3 dimensional deformity and in contrast to Mees lines the thumb is usually not involved 1 2 Muehrcke s linesOther namesApparent leukonychia striata Muehrcke s lines are a strong indicator of hypoalbuminemia which can result from a variety of different causes 3 4 The lines are actually in the vascular bed underneath the nail plate As such they do not move with nail growth and disappear when pressure is applied to the nail blanching the underlying nail bed this distinguishes them from true leukonychia striata such as Mees lines 1 As in Terry s and half and half nails the pattern is thought to be formed by bands of localized edema exerting pressure on the surrounding capillaries 3 5 Contents 1 Physiology 2 History 3 See also 4 References 5 BibliographyPhysiology editThe appearance of Muehrcke s lines is associated specifically with marked hypoalbuminemia serum albumin 2 2 g dL indicating decreased protein synthesis which may occur during periods of metabolic stress e g systemic infection trauma AIDS chemotherapy or in hypoalbuminemic states such as the nephrotic syndrome or dietary protein deficiency They are also seen in patients with end stage kidney disease on hemodialysis Hodgkin s disease pellagra and sickle cell anaemia 3 6 7 8 9 The lines remain visible as long as protein intake is inadequate or synthesis is impaired and they should disappear upon return to normal function 3 In extreme conditions Muehrcke s lines may also arise from physical changes in peripheral circulation one case study reported appearance of the lines in a healthy subject following ascent to 8 848 meters 29 029 ft on Mount Everest 10 History editMuehrcke s lines were described by American physician Robert C Muehrcke 1921 2003 in 1956 In a study published in BMJ he examined patients with known chronic hypoalbuminemia and healthy volunteers finding that the appearance of multiple transverse white lines was a highly specific marker for low serum albumin no subject with the sign had SA over 2 2 g dL was associated with severity of the underlying condition and disappeared upon successful treatment corticosteroids in nephrotic syndrome or direct infusion of HSA 4 See also editMees lines a similar appearance except the lines are in the nail and move as the nail grows Half and half nails Terry s nails List of cutaneous conditionsReferences edit a b Rapini Ronald P Bolognia Jean L Jorizzo Joseph L 2007 Dermatology 2 Volume Set St Louis Mosby ISBN 978 1 4160 2999 1 Zaiac Martin N Walker Ashley September 2013 Nail abnormalities associated with systemic pathologies Clinics in Dermatology 31 5 627 649 doi 10 1016 j clindermatol 2013 06 018 ISSN 1879 1131 PMID 24079592 a b c d Singal Archana Arora Rahul 2015 Nail as a window of systemic diseases Indian Dermatology Online Journal 6 2 67 74 doi 10 4103 2229 5178 153002 ISSN 2229 5178 PMC 4375768 PMID 25821724 a b MUEHRCKE RC June 1956 The finger nails in chronic hypoalbuminaemia a new physical sign Br Med J 1 4979 1327 8 doi 10 1136 bmj 1 4979 1327 PMC 1980060 PMID 13316143 Hinds Ginette Thomas Valencia D January 2008 Malignancy and cancer treatment related hair and nail changes Dermatologic Clinics 26 1 59 68 viii doi 10 1016 j det 2007 08 003 ISSN 0733 8635 PMID 18023771 Freedberg Irwin M et al eds 2003 Fitzpatrick s dermatology in general medicine 6th ed New York NY McGraw Hill p 659 ISBN 978 0 07 138076 8 Bianchi L Iraci S Tomassoli M Carrozzo AM Nini G 1992 Coexistence of apparent transverse leukonychia Muehrcke s lines type and longitudinal melanonychia after 5 fluorouracil adriamycin cyclophosphamide chemotherapy Dermatology 185 3 216 7 doi 10 1159 000247451 PMID 1446089 Chapman S Cohen PR April 1997 Transverse leukonychia in patients receiving cancer chemotherapy South Med J 90 4 395 8 doi 10 1097 00007611 199704000 00006 PMID 9114829 S2CID 29031413 Morrison Bryant M Gradon JD 2007 Muehrcke s Lines N Engl J Med 357 9 917 doi 10 1056 NEJMicm065055 PMID 17761595 Windsor Jeremy S Hart Nigel Rodway George W 2009 Muehrcke s Lines on Mt Everest High Altitude Medicine amp Biology 10 1 87 88 doi 10 1089 ham 2008 1079 ISSN 1557 8682 PMID 19278357 Bibliography editFawcett Robert S Sean Linford Daniel L Stulberg March 15 2004 Nail Abnormalities Clues to Systemic Disease American Family Physician 69 6 1417 24 PMID 15053406 James William Berger Timothy Elston Dirk 2005 Andrews Diseases of the Skin Clinical Dermatology 10th ed Saunders ISBN 0 7216 2921 0 Muehrcke Lines of the Fingernails at eMedicine Muehrcke s Lines of the Fingernails on WebMD Retrieved from https en wikipedia org w index php title Muehrcke 27s nails amp oldid 1188102263, wikipedia, wiki, book, books, library,
