Mees' lines in a patient following acute arsenic intoxication

A 62‐year‐old Turkish man developed nausea and vomiting 1 h following a dinner with friends and business associates. In the following few days, he developed dark urine, anemia, and thrombocytopenia. Five of his dinner companions developed similar symptoms of varying degrees, and one died. It is unknown how their food and beverage consumption differed during the meal. During the subsequent month, the patient developed gait ataxia, leg weakness, and burning pain and numbness in a glove‐and‐stocking distribution. Six weeks later, he traveled to the USA and was evaluated by our Department of Neurology. An electromyogram demonstrated generalized peripheral polyneuropathy, with motor and sensory axon loss. The patient was referred to the Department of Dermatology for evaluation of possible arsenic poisoning. Cutaneous examination revealed one transverse white band on several fingernails approximately 3–4 mm distal to the proximal nail fold, consistent with Mees’ lines ( Fig. 1 ). A plaque of confluent 3‐mm hypopigmented macules was evident on the extensor aspect of the left forearm ( Fig. 2 ). Hair, nail, and urine samples were obtained to rule out heavy metal poisoning; the arsenic levels obtained were 27.6 µg/g (normal, 0.03–3 µg/g), 2.98 µg/g (normal, 0.03–3 µg/g), and 82 µg/L (normal, < 81 µg/L), respectively.

Figure 1 Open in figure viewer PowerPoint Mees' lines present on the fingernails     

Transverse Leukonychia (Mees' Lines) Due to aunorubidn Chemotherapy

Abstract: Transverse bands of leukonychia are reported in a 7-year-old boy foilowing a 10-day course of daunorubicin given for the treatment of lymphoblastic leukemia, A variety of other chemotherapies did not induce any nail changes in this patient.     

Pigmentary demarcation lines

The natural pigmentary demarcation boundaries of the skin can be classified as: Group A--lines along the upper limb with variable trans-pectoral extension; Group B--lines along the lower limb; Group C--paired lines in median or paramedian course on the chest with midline abdominal extension; Group D--posteromedian demarcation; and Group E--bilaterally symmetrical, obliquely oriented hypopigmented macules on the chest. Groups A and C are the most distinct and occur in both Negroes and Japanese.     

Juxta-clavicular beaded lines

We present a case series of 63 patients diagnosed with juxta-clavicular beaded lines. This condition is more frequent in dark-skinned people and corresponds to an anatomical variant of simple sebaceous hyperplasia. In view of the strong reactivity of the melanocytes in dark-skinned people, and of the possible hypochromic results, no treatment is advised.     

Relaxed skin tension lines

In order to obtain the least scarring following a surgical procedure, it is crucial that the surgeon always consider the direction of the relaxed skin tension lines involved in the procedure and attempt to obtain a scar that follows that direction as much as possible. No other factor (except the region where the surgery is to be performed) is as important in obtaining an acceptable scar, including the too frequently heralded factor, surgical technique. This article deals with the determination and surgical application of the relaxed skin tension lines.     

Along these lines..

Non‐melanotic discoloration of the skin can result from the accumulation of various internal agents (ingestion, inhalation, or injection), chemicals or drugs, such as heavy metals, amiodarone, tetracycline, clofazimine and others, or exogenous (topical) substances. Identifying the causative agent frequently requires a thorough investigation and clever detective work, including visits to the home and workplace. It is, however, rare that the patient presents at a clinic with the corpus delicti, and it is even more rare when neither the patient nor the treating physician are initially aware of it. “What is the hardest of all? That which you hold the most simple; seeing with your own eyes what is spread out before you.”[J.W. Goethe quoted by J.P. Eckermann in Converstions with Goethe, May 18, 1824.]     

Erythema multiforme along Blaschko's lines

A case of erythema multiforme along Blaschko's lines is reported in a 20-year-old female suffering from recurrent herpes labialis. Histological examination was compatible with the clinical features. Spontaneous resolution followed in 4 weeks without therapy.