Management of Mees Lines
Mees lines do not require specific treatment as they are a clinical sign of systemic illness rather than a primary condition requiring direct intervention. The management should focus on identifying and treating the underlying cause that led to their development.
What Are Mees Lines?
Mees lines (transverse striate leukonychia) are horizontal white bands that appear across the nails and:
- Move distally as the nail grows
- Affect multiple nails simultaneously
- Represent a temporary disruption in nail formation due to systemic illness
Underlying Causes
Mees lines can appear in various conditions:
- Arsenic poisoning (classic association) 1
- Systemic infections (parasitic, helminthic, amebic) 2
- Systemic lupus erythematosus flares 3
- Chemotherapy 4
- Other severe systemic illnesses
Diagnostic Approach
Detailed History:
- Recent severe illnesses or hospitalizations
- Exposure to arsenic (environmental or occupational)
- Autoimmune disease history, particularly SLE
- Recent chemotherapy
- Symptoms of parasitic infections
Physical Examination:
- Document appearance and distribution of nail changes
- Look for other signs of systemic illness
- Differentiate from other nail bands:
- Muehrcke lines (don't move with nail growth) 5
- Beau's lines (actual grooves rather than color changes)
Laboratory Testing (based on clinical suspicion):
- Heavy metal screening if arsenic exposure is suspected
- Autoimmune panels if SLE is suspected
- Stool studies if parasitic infection is suspected
- Complete blood count and metabolic panel
Management Algorithm
Document the Mees Lines:
- Photograph the affected nails
- Mark the proximal edge to monitor growth over time
Identify and Treat the Underlying Cause:
- For arsenic poisoning: Chelation therapy
- For autoimmune disease: Appropriate immunosuppression
- For infections: Targeted antimicrobial therapy
- For chemotherapy-related: Supportive care
Patient Education:
- Explain that Mees lines represent a past systemic insult
- Reassure that they will grow out with the nail (3-6 months for fingernails)
- No direct treatment of the nail itself is necessary
Follow-up:
- Monitor for resolution of the underlying condition
- Observe nail growth to ensure no new lines are forming
- Consider the appearance of new lines as potential indication of disease recurrence or new systemic insult
Clinical Pearls
- Mees lines can serve as a chronological marker of previous systemic illness, particularly in SLE where they may correspond to previous disease flares 3
- Unlike Muehrcke lines which remain stationary, Mees lines move distally with nail growth
- The presence of Mees lines should prompt investigation for serious underlying conditions, particularly if the cause is not immediately apparent
- In children receiving chemotherapy, approximately one-third may develop nail changes, with Mees lines being one possible manifestation 4
The most important aspect of managing Mees lines is recognizing them as a clinical sign that requires investigation of the underlying cause rather than direct treatment of the nail abnormality itself.