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white bands on my nails

For the past two weeks my nails developed some white lines across my nails and when I bend my fingers these lines or bands turn pink. I also feel pressure and sometimes pain under them and around my fingertips. I've been to two doctors and they don't know what it is. My blood tests are normal. I have fibromyalgia.
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1081992 tn?1389903637
Hi, do they look like this?
https://www.nejm.org/doi/full/10.1056/NEJMicm065055

"when I bend my fingers these lines or bands turn pink"
That sounds like your nails themselves are smooth, and the lines are underneath the nails, correct?
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Yes it look like that. The lines are underneath. I don't know what to do, the doctors tell me not to worry but these sensations I have on the nails are weird and uncomfortable
1081992 tn?1389903637
"Yes it look like that. The lines are underneath."
Bem, then this seems very possible to understand. The short answer is that you should have a blood test for low albumin.


Next, please look at the following, and you should also show that article to your doctor(s) because that is a reputable source:
https://www.webmd.com/skin-problems-and-treatments/guide/muehrcke-lines-of-the-fingernails#1-3

Note especially that "When you press down on the fingernail, the lines temporarily disappear." That is very specific to "Muerhcke's Lines".

The lines are linked to low levels in the blood of a normal protein called albumin. When albumin is low, your blood vessels tend to leak clear fluid and cause swelling. That swelling is called "edema", and it can explain the sensations that you have.

Hypoalbuminemia is the term for having low levels of albumin ('hypo' = low, 'emia' = bloodstream). So let's look at that on another reputable site:
https://emedicine.medscape.com/article/166724-overview#a7

which says that the cause is "most commonly, acute or chronic inflammation". You have fibro, which brings chronic inflammation. If your kidneys are inflamed, then "Nephrotic syndrome" means you excrete too much albumin ('nephro' = kidney). Plus, that page tells that inflammation also causes low albumin in other ways. Do you happen to have gained a lot of water weight, without eating excess calories?

If your blood test shows low albumin, then your doctor can order the 24 hour *urine* test for albumin. Here we see that fibromyalgia is known to cause too much urinary albumin excretion:
https://www.ncbi.nlm.nih.gov/pubmed/23588409/
"24-h UrinaryAlbuminExcretion was independently correlated with... the presence of FM", especially if you have high blood pressure.

So that's a lot terms, but hopefully you can see the logic in it. There's also one other thing. In an older post of yours, you said that you have had encephalopathy, as seen on MRI. Later on in that 2nd article:
https://emedicine.medscape.com/article/166724-clinical#b2

...we see that low albumin also is associated with encephalopathy. You also might have other problems on that list there, besides possibly the edema (water weight gain) all over, even in the face.

Please let me know how this turns out, I'm very curious. Good luck.
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I know that's a lot to read through and absorb, but since you have fibro, you are used to complex medical things - and reversing the possible hypoalbuminemia might give you improvement in many symptoms all around. Was everything understandable enough?
Thank you for your answer and your time. You've explianed more to me than my doctors. I've done some blood tests on my own, including albumin, and all was normal. I've talked with people with fibromyalgia on the internet and also with people with celiac disease (I might have gluten intolerance) and it seems a lot of people have nails like mine. But I just want to know what I really have so I talked with a doctor online and he told me that I could have raynaud's syndrome and that is what causes the discoloration of my nails.
1081992 tn?1389903637
"I talked with a doctor online and he told me that I could have raynaud's syndrome and that is what causes the discoloration of my nails"
Oh boy... I had to LOL at that :)  I've seen someone live with that happening right in front of me.  It results in splotchy colors, even bluish/purple. It's in the fingertips, not in the nail beds. Did you look up photos of Raynaud's?

Well, you did the albumin test on your on so gthagt shows that you are veery norivated.
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Oops, that went out on its own while I was correcting my typing, sorry. Dell laptop keyboards go awry. Resuming...


...so that shows that you are very motivated. Bravo.

Why did you suspect low albumin? Do you think it is possible that your albumin levels can vary a lot, week to week? Perhaps it is low now, but wasn't when you were tested?

I've read that it is highly specific, which means that there really isn't much else to suspect for how it looks like and behaves.

I'll look up the DDx...




1081992 tn?1389903637
(Btw, I hope you realize that I was laughing at what the online doc said, not at you. It just was somehow so spontaneously funny :)  Besides, Raynaud's is a reaction to cold, and it doesn't last for weeks.)


Well, here's a supposed Differential Dx for Muehrcke's Lines:
https://emedicine.medscape.com/article/1106423-differential

...but at a glance that page doesn't seem right. None of the ones I checked seem even close, e.g. infections. Beau lines are in the nails, not the nail beds. And so on.

Did anything happen before you saw the bands appear? Worsening of the fibro? A change to a low protein diet?

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I did the test for albumin because I searched online and found muehrcke lines, like you said, and thought I might have it. Also I did blood tests related to other causes of muehrcke lines, like the renal issues, but everything is normal.

I also thought that this can't be raynauds because I never had skin discoloration, however sometimes I have tingly, sweaty and cold hands that feels swollen, especially the right one. I had this for years.

I am vegan and had anemia for a few years, lately I've been eating junk food and following an unhealthy diet, but most of the time I eat well.

When this lines appeared on my nails I started to feel more tired and with a lot of dizziness. But all the doctors tell me it is all in head and the cause is anxiety, but I know that it's not. I just don't know what else to do or with I should talk to, I already spend a lot of money with doctors and tests. Everyone says it's fibromyalgia/anxiety related.

1081992 tn?1389903637
Here's a photo of Mees' lines, though that seems to be in the nail plate, not the nail bed -- and seems to be caused by a toxin or other shock to the system. You can make some measurements to be sure that your bands are not moving as the nails grow.
https://casereports.bmj.com/content/12/3/e229644

"vegan"
You seem very competent, so I'll assume you use or have recently tried methyl B12, just to see if that helps.

"all the doctors tell me it is all in head and the cause is anxiety, but I know that it's not"
There are so very many people around the world with rare conditions that are told that it's all in their head. Of course that's not true in your case, as can be seen with your nail bed lines.

Well, maybe the way to proceed is to guess that whatever you have mimics the way that hypoalbuminemia creates Muehrcke's lines - but still is different. That could be something else that creates edema. Do you have any other signs of edema?

Also whatever that is, must also create "tingly, sweaty and cold hands that feels swollen". So maybe that's not so far from Raynaud's after all. Though Raynaud's looks very very different:
https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/peripheral-arterial-disease/raynaud-syndrome
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I also have the same symptoms in my feet, but without the lines on my nails. The only thing I can think about is some vitamin deficiency. I think the  other causes of  muehrcke's lines don't apply to me since I have normal blood tests.
1081992 tn?1389903637
Have you tried methyl B12? Or the methylated types of folate? Some people cannot methylate well. Have you heard of MTHFR?
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No, I've never heard of it. I have an appointment with a different doctor on tuesday and I will tell him what you've said to me. Thank you a lot for your help, you've done more than my doctor.

I realized I didn't post a link with the photos of my nails. Here it is if you want to see.
https://imgur.com/a/y45XLGd
the lines are more visible on the thumbs. The other nails are pale with a red/pink line in the middle
1081992 tn?1389903637
The pictures are very helpful, obrigada. To me that doesn't look like Muehrcke's, but I don't see colors well so I could be very wrong. It most certainly does not look at all like Raynaud's.

Any doctor will not care what I've said, of course. But hopefully this has helped your thinking somewhat. Maybe swelling is a key somehow.

Or because of the paleness, maybe low iron is a problem? Did you have the ferritin test? Testing mineral levels in the blood is said to be not the best way. It also takes a long time to regain enough iron in your system, if you were low in the past.

"methylation" is something like activating of vitamins etc. Without that, they don't do much. MTHFR is a genetic condition where people don't methylate enough, so they'd have to take pre-methylated vitamins.

Let me know how things go.

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