What Is Brittle Nail Syndrome? Dr. Badran Answers

Brittle nail syndrome is characterized by the roughness of the surface of the nail plate, fragility or raggedness of the distal nail, and splitting and peeling.

Brittle nails affect 20% of the population and are diagnosed most frequently in elderly inpiduals. Women are affected twice as frequently as men. It is due to an abnormality of keratin, keratin-associated proteins, water, and/or lipid content.

Clinical features of brittle nail syndrome are onychoschizia (horizontal splits within the nail plate), onychorrhexis (increased longitudinal ridging, or splitting), and onycholysis (detachment of the nail plate from its bed). While some patients present to the physician due to cosmesis, many complain of pain with a negative impact on daily activities.

Brittle Nail Syndrome Causes

It is usually idiopathic, but there are some dermatological and systemic diseases that can be associated with secondary brittle nail syndrome. Dermatologic conditions include lichen planus (a condition that can cause swelling and irritation in the skin, hair, nails and mucous membranes) and alopecia areata.

Systemic diseases include hypopituitarism, hypothyroidism and hyperthyroidism, diabetes mellitus, malnutrition, Raynaud disease, and polycythemia vera.

Nail splitting may also be caused by nail cosmetics (hardeners, polish, polish removers/solvents), nail procedures, and occupational exposure to various chemicals (alkalis, acids, cement, solvents, thioglycolates, salt, sugar solutions). Injury may also play a role in the development of brittle nails.

Alopecia Areata

Alopecia areata is a chronic, autoimmune disease. The main symptom is massive hair loss, localized or diffuse, in the scalp and the whole body. However, nails may also be involved, and brittleness, fragility and pitting can be signs of nail dystrophy in alopecia areata patients. Nail changes are a common feature of alopecia areata and are a significant source of cosmetic disfigurement and functional impairment.

The reported incidence of nail involvement in alopecia areata ranging from 9% to 46% . Incidence is much lower in patients with focal alopecia areata than in patients with severe forms of alopecia areata and may be higher in children than in adults . Nail changes may either precede the hair loss or occur months or years later, and may persist even after hair regrowth.

The nails are similar in structure and growth to hair follicles and they are affected by the same inflammatory reaction that targets hair follicles in alopecia areata.

Onychoschizia

Onychoschizia is a horizontal splitting of the distal nail plate into layers at the free edge. It is a very common problem among women and represents a dyshesion of the layers of keratin, possibly as a result of dehydration. It can affect nearly anyone.

Too much or too little moisture, usually due to external factors, is the most likely cause of brittle nails. Frequent wetting and drying of the hands is the most common cause of nail splitting, so this condition is, therefore, common among house cleaners, nurses, and hairdressers.

Too little moisture is the reason that people are more likely to have dry nails in hot, dry environments or during the winter months. When a person’s nails are hard and brittle, the nails lack enough moisture. Frequent wetting and drying of the nails from activities such as hand washing or doing the dishes can strip the moisture from the nails.

Too much moisture can happen as a result of using too much moisturizer on the hands. It could also be the result of using harsh chemicals such as acetone to remove nail polish.

Anemia, is a condition where your body lacks enough hemoglobin, a protein that carries oxygen from your lungs to the rest of your body. While fatigue is the leading sign of anemia, this condition can also show itself through brittle or spoon-shaped nails — called koilonychia.

Thyroid disorder ( too many or too few hormones ) can affect the body’s absorption of minerals and as a result, a person’s nails may split away from their beds.

Age can affect the strength of a person’s nails. Nails naturally decrease in strength over time, which can cause them to break more easily.

Onychorrhexis

Onychorrhexis is a condition that causes vertical ridges to form on the fingernails. Instead of a relatively smooth fingernail, a person with onychorrexis will have grooves or ridges in their nails. Some people may have this condition on only one nail while others will have it on all nails.

Changes to the fingernails can sometimes suggest an underlying medical condition or nutritional deficiencies.

Some of the potential onychorrexis causes include: amyloidosis ( a condition that causes excess levels of the amyloid protein to build up in the body), anemia, eating disorders, such as bulimia ( a psychological eating disorder in which you have episodes of consuming a large quantity of food in one sitting), eczema, excessively picking or biting at the nails, exposure to chemicals and excess moisture, such as those in the occupations of hairdresser or housekeeper, frequent use of nail polish remover, which can thin the nail, hypothyroidism, lichen planus, an inflammatory skin disorder, psoriasis, rheumatoid arthritis or trauma to the nails.

Onychorrhexis has also been linked with nutritional deficiencies. Examples include deficiencies of folic acid, iron, or proteins. The body needs these nutritional components to produce healthy, strong nails. Advancing age also causes onychorrexis. The nails tend to become thinner and more brittle as you age, which can make lines in the nails more pronounced.

Onycholysis

Onycholysis is the painless separation of the nail from the nail bed. Onycholysis is a common nail disorder. It can be a sign of skin disease, an infection or the result of injury, but most cases are seen in women with long fingernails. The nail acts as a lever, prying the nail away from the skin and preventing healing of otherwise insignificant insults.

It may be idiopathic or secondary to trauma, skin disease, nail infections, tumours, or systemic events. A local irritation is the most common insult. This may be from excessive filing, chemical overexposure in manicures or nail tip application, allergic contact dermatitis to nail hardener or adhesives used to attach the nail tips, or simply to prolonged immersion in water. Fungal infection , psoriasis and certain medications can also cause onycholysis. One can get sunburn under the nails, which causes onycholysis.

Prevevention Tips

Moisturize your hands after washing. When applying the lotion or cream, be sure to rub it around and directly on your nails. Look for moisturizing hand lotions that contain lanolin or alpha-hydroxy acids. Before going to bed, moisturize your hands, feet, and nails to keep them hydrated as you sleep.

Protect your hands and avoid prolonged exposure to cold, dry weather. If you do venture outside on a cold day, be sure to wear gloves. When doing household chores, wear gloves, such as dishwashing gloves, to keep your hands dry.

Keep your nails short to minimize nail surface area, where water and chemicals can be absorbed. Don’t pick or bite your nails or cuticles. You can use a metal instrument to push back the cuticle, but avoid using it directly on your nail. Buff your nails in the same direction as the nail grows. Avoid back-and-forth motion that can cause splitting.

Opt for a nail polish remover that doesn’t contain acetone, and try to avoid frequent use of the remover.

Taking biotin vitamin supplements may be effective in about one-third of all cases. Other supplements to consider include colloidal minerals, gelatin, and calcium. Getting adequate protein in the diet. Eating iron-rich foods.