Photo Rounds

Lines across fingernails

A 32-year-old man with Hodgkin's disease asked his family physician (FP) to take a look at the unusual appearance of his nails. He told the FP that he had just finished his last round of chemotherapy. The patient was encouraged by the results of the chemotherapy, but was concerned about the look of his nails.

What's your diagnosis?


The FP diagnosed Mees’ lines in this patient.

Mees’ lines spread transversely across the entire breadth of the nail and are somewhat rounded, with a contour similar to the distal lunula. Mees’ lines tend to occur on several nails at once. A history of a systemic insult is correlated with the onset of the lines, such as chemotherapy, heart failure, or arsenic poisoning. In this case, each transverse white band across the nail correlated with a round of chemotherapy.

The FP explained the correlation between the white bands and the chemotherapy and told the patient that since the chemotherapy was complete, the white bands would grow out over time (probably in a couple of months).

Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photo courtesy of Jeff Meffert, MD. This case was adapted from: Mayeaux EJ. Normal nail variants. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:819-821.

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