Pathogenesis, Clinical Signs and Treatment Recommendations in Brittle Nails: A Review

Abstract

Nail plate brittleness (or fragility) is a common complaint affecting up to 20% of the population, especially women over 50 years of age, with fingernail fragility being more prevalent than toenail fragility. Nail brittleness is characterized by nails that split, flake and crumble, become soft and lose elasticity. The main clinical presentations are: onychoschizia, onychorrhexis, superficial granulation of keratin and worn-down nails. According to causative factors, we can distinguish 2 forms of nail fragility (NF): a primary ''idiopathic or brittle nail syndrome'' form and NF secondary to different causes such as inflammatory nail disorders, infections, systemic diseases and general conditions, traumas and alteration of the nail hydration. Optimal management requires treatment of the primary cause of brittle nails, when possible. In idiopathic NF oral supplementation, vitamins (especially biotin, also known as vitamin B7), trace elements and amino acids (especially cysteine) have been reported to be useful. In addition, several products, such as topical moisturizers and lacquers could be considered to restructure the affected nail plate and to reduce psychological impacts of this common problem.

Common diseases of the nail: Diagnosis and therapy

“…Symptoms include grooves and longitudinal tears (onychorrhexis), horizontal splits (onychoschisis), diagonal splits, superficial granulation, worn‐off nails, and friability [54]. Apart from the primary (idiopathic) form, there are secondary variants due to mechanic, microbiological, nutritive, medicinal, and disease‐specific influences [55]. Treatment is usually symptomatic; a podologist can apply techniques that re‐structure and stabilize the nail plate.…”

Hair, Nail, and Skin Changes during COVID 19 Era

“…Regarding nail involvement and affection by recurrent hand washing and using sensitizers, about 60% of cases showed brittle nails. Brittleness of the nails is identified as nails that split, flake, and crumble, become soft and lose elasticity as Chessa etat 19 gave the definition in their work and reported that normal nails contain 5% lipids, as we mention before frequent hand wash effect the hand PH also decrease water content in the nail plate (< 16%) 11 .…”

Leukonychia: What Can White Nails Tell Us?

“…Punctate areas of leukonychia due to fungal invasion can eventually coalesce to involve the entire surface of the nail plate or may present with a single or multiple transversal leukonychial bands separated by a normal nail plate [ 32 , 33 ]. Artificial nails and frequent use of polish removers damage the superficial layers of the nail plate causing dehydration of the nail keratins that clinically appear as fine and scaling white spots (keratin granulation) [ 34 ]. The use of cyanoacrylate glue should also be excluded.…”