To the Editor.—
Many children and teen-agers and a few adults have white spots in the fingernails. These occur more frequently in the nails of the index and little finger of the dominant hand, ie, right hand for the right-handed individuals. Trauma is thus a factor, but not the primary cause, since patients with numerous white nail spots will also have such spots in the toenails. White banding may occur in the nails of both hands.Attention was called to these spots or paired bands by Muerhcke1 (1956) who ascribed the phenomenon to a serum albumin level lower than 2.2 gm/100 ml. His largest group of patients suffered from nephrosis, and those of the second group had hepatic cirrhosis. All had low serum albumin levels. Two patients responded to cortisone therapy with disappearance of the white banding, and several patients responded to albumin-replacement therapy. We now find, in a
Pfeiffer CC, Jenney EH. Fingernail White Spots: Possible Zinc Deficiency. JAMA. 1974;228(2):157. doi:10.1001/jama.1974.03230270017005
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