Muehrcke's Lines of the Fingernails

Medically Reviewed by Debra Jaliman, MD on January 26, 2022

Muehrcke's lines appear as double white lines that run across the fingernails horizontally.

The condition is named after Robert Muehrcke, MD. He first described the condition in the British Medical Journal in 1956.

Symptoms of Muerhcke's Lines

Muehrcke's lines usually affect several nails at a time. There are usually no lines on the thumbnails.

Some characteristics of Muehrcke's lines are:

  • White bands go across the entire nail from side to side.
  • Lines are usually most clearly seen on the second, third, and fourth fingers.
  • The nail bed looks healthy in between the lines.
  • The lines do not move as the nail grows.
  • The lines do not cause dents in the nail.
  • When you press down on the fingernail, the lines temporarily disappear.

Causes of Muehrcke's Lines

The exact cause of Muehrcke's lines is not clearly understood. The lines are not caused by injury to the cuticle or nail area.

The lines have been linked to low levels of a protein called albumin. Albumin is found in the blood. It is made in the liver.

Albumin plays an important role in many body functions. It keeps fluid from leaking out of your blood vessels. It also helps move hormones, vitamins, and medicines through your body.

Although low albumin level is most commonly linked to liver disease, many different systemic (body-wide) diseases can cause low albumin levels. Muehrcke's lines have been seen in people with:

One possible theory for the appearance of Muehrcke's lines is that these diseases lead to swelling in the nail bed. The swelling puts pressure on the blood vessels that run underneath the nail, causing color changes.

The lines have also been seen in older people receiving chemotherapy who have normal albumin levels. However, Muehrcke's lines most often occur in those with too little albumin.

Treatment of Muehrcke's Lines

If your albumin level is too low, you may be given albumin through a vein (by IV, or intravenously).

The lines tend to go away when your albumin level returns to normal, or near normal. However, a normal range may vary, depending on the lab that tested your blood. Always talk to your doctor about your test results.

Other treatment depends on the disease or disorder that caused the fingernail changes.

Show Sources


American Family Physician Web site: "Nail Abnormalities: Clues to Systemic Disease."

The American Journal of Medicine Web site: "Muehrcke's Lines."

Lab Tests Online web site. "Albumin: The Test."

Scher, R.K. Scher & Daniel: Nails: Diagnosis, Therapy, Surgery, 3rd ed., Saunders Elsevier, 2005.

James, W.D, Berger, T.G., Elston, D.M., eds. Andrews' Diseases of the Skin: Clinical Dermatology, 11th ed., Saunders Elsevier, 2011.

Merck Manual for Health Care Professionals Web site: "Acrocyanosis."

Muehrcke, R. British Medical Journal, 1956.

The American Journal of Medicine, November 2010.

Morrison-Bryant, M. New England Journal of Medicine, 2007.

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