Muehrcke’s lines related to chemotherapy

At a first look to the small thumbnail I thought it was psoriasis. But the correct response was different: Muehrcke’s lines related to chemotherapy. From the NEJM image challenge.

“Muehrcke’s lines are the two smooth white bands that run parallel to the lunula across the width of the nail. The lines are nonpalpable and, unlike Beau’s lines, do not indent the nail itself. Muehrcke’s lines are a nonspecific finding that may be associated with periods of metabolic stress, which transiently impairs protein synthesis. Muehrcke’s lines are also caused by infections and trauma”.

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