Muehrcke Lines
Several disease states that cause hypoalbuminemia may be associated with Muehrcke lines. The appearance of paired, white bands is most likely due to a chronic nutritional deficiency of albumin. Examples include nephrotic syndrome, glomerulonephritis, liver disease, and malnutrition. Even though the white bands are most often seen in patients with nephrotic syndrome (of which many causes exist), they are not specific for any one disease state. Additionally, a case of Muehrcke lines has been reported after trauma.
Treatment
Should be undertaken in a case-specific manner. In patients presenting with paired, white, transverse lines due to a serum albumin deficiency, albumin infusions to raise the serum level aid in the disappearance of Muehrcke lines. Treatment of the underlying disease additionally aids in correcting the abnormal serum albumin levels.
Muehrcke1 reported on the effects of intravenous albumin, cortisone, and corticotrophin therapy on the white bands. A 44-year-old engineer with amyloid disease presented with gross proteinuria, white bands on all the fingernails (except the thumb), and a serum albumin level of 1.9 g/100mL. Over the course of 3 weeks, he was given a total of 750g of albumin, resulting in a transitory increase in the serum albumin level. After 3 weeks of the albumin infusion, the white bands almost completely disappeared. However, 3 months later, the serum albumin level decreased again, and the bands reappeared.
In a similar fashion, a patient with nephrotic syndrome due to subacute membranous glomerulonephritis received an infusion of 750g of albumin, which increased his serum level from 2.2g/100mL to 3.4g/100mL. As a result, the white bands became progressively less visible. Once the serum albumin level returned to the reference range, the white bands fully disappeared.1
A third patient with nephrotic syndrome, with a serum albumin level of 1.6 g/100mL, and with prominent white bands was treated with cortisone therapy over 3 months. At the end of the 3-month period, her serum albumin level increased to 2.9 g/100mL, and the white bands disappeared.
A 14-year-old boy with anasarca, with a serum albumin level of 1.5 g/100mL, and with white fingernail bands received 10 days of corticotrophin therapy, followed by a cortisone maintenance treatment. Over the course of several months, his albumin level increased to 3.7g/100mL, and the white bands disappeared.1 Large amounts of multivitamin injections did not have any effect on the appearance of the white bands in the fingernails of patients.