Ridges in nails usually come from aging but can also indicate improper nail care, nail trauma, vitamin deficiency, or even a more pressing medical condition, according to 2022 research. Horizontal ridges can point to issues like malnutrition, serious nail injury, or even Beau’s lines. Vertical ridges are often an indication of aging.
Ridges in your nails are usually harmless but can mean different things. They were originally associated with cirrhosis, but have now been documented in up to 25% of hospitalized patients in general.Frequently asked questions What do ridges in your nails mean? In Terry's nails, most of the nail plate turns white (the lunula is obliterated) with a characteristic ground glass appearance secondary to a decrease in vascularity and an increase in connective tissue in the nail bed. They are often associated with arsenic poisoning, other metal toxicity, congestive heart failure, and some infections. Mees' lines (also known as Aldrich or Reynolds' lines) are white, non-blanching (an important distinguishing feature from Muehrcke's nails), transverse bands running parallel to the lunula secondary to an insult to the distal nail matrix causing parakeratosis of the ventral nail plate. Beau's lines are perceptible and palpable deep grooved ridges running side-to-side on the fingernail or toenail secondary to a temporary delay in nail division in the nail matrix (e.g., infection, trauma). The most pertinent clinical conditions on the differential diagnosis for Muehrcke's nails are Beau's lines, Mees' lines, and Terry's nails. Associated melanonychia may also be present in patients undergoing chemotherapy. The white lines disappear with pressure (hence the term ‘apparent’ leukonychia). Muehrcke’s nails are often present on the second, third, and fourth fingernails, whereas the thumbnail is rarely involved. These white bands are only different in color and have no other palpable difference compared to the rest of the nail. On physical examination, the transverse white bands run parallel to the lunula and are separated by areas of normal pink nailbed color. However, treatment with systemic anticancer drugs (particularly taxanes or EGFR inhibitors) may result in nail changes, pain, and functional impairments. A review of systems should also be probed, although this condition is typically benign. The chronology of nail findings in relation to history should be understood. Questions about patients’ underlying medical conditions, exposures, medication, and occupation should be included. These may not be true cases of Muehrcke's nails as associated with hypoalbuminemia, as originally reported by Muehrcke.Īs the possible causes of Muehrcke’s nails grow, a complete and detailed history is important to elicit an etiology. These may also more often be transverse bands of pigment. It is known that nail changes, including pigmentation changes and dystrophy, can occur with chemotherapy. This theory is corroborated by an array of studies documenting this finding in patients with hypoalbuminemia, ranging from 3.4 g/100 mL) and even normal albumin levels. As a result, the normal appearance of erythema observed through the nail plate is not seen. Although the exact pathophysiology is unclear, it is thought that a localized edematous state in the nailbed results in increased pressure on the vasculature in this region. Typically, Muehrcke's nails are the result of hypoalbuminemia.
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