Chapter 16: Nail Fragility

SUMMARY

• Nails that are weak, soft, easily broken or split are considered fragile nails.¹

• Nail fragility is mainly idiopathic but can derive from a combination of internal and external factors.

• Fragile nails are prevalent among postmenopausal women and geriatric populations (over 60 years).^3–6

TIPS FOR DIAGNOSIS

• Nail splitting, peeling, ridging, and worn-down nail appearances (Fig. 16.1).^2,8

• Consider internal factors by thoroughly evaluating the patient’s age, sex, medical history, social history, prescription medication history, food consumption groups and diet, and nutritional deficiencies.⁷

• Consider external factors: patient’s duties (clerical, medical, housework, etc.), occupational environment, hand wash frequency, nail trauma history, nail grooming habits, hand sanitizer usage, and salon manicures (type, frequency).

TIPS FOR TREATMENT

• Clip nails short and round corners to reduce nail breakage.⁹

• Remember to moisturize nails after handwashing.

• Eat well-balanced meals and avoid crash diets. Meals rich in vitamins, protein, and biotin-rich foods are the essential building blocks to healthy strong nails.

• Consider wearing gloves to protect nails from physical and chemical environmental exposures and micro-traumas.

DON’T FORGET

• Occupations that require repeated wetting and drying of hands (hairdressers, nursing, nail technicians) or exposure to harsh solvents (acetone, detergents, dish soap, furniture polish, paints) can leave nails dry and prone to fragility.^9,10

• Be mindful of how much water nails are exposed to.

• Ask your doctor if biotin supplementation is safe for you.

PITFALLS AND CAUTIONS

• Multiple conditions, including dermatological disorders may lead to brittle nails.

• Advise patients to stop biotin supplementation 1 week before blood drawing for laboratory examinations.⁷³

EXPERT PEARLS

• Moisturize nails after water exposure at least twice a day with the following: lotion, lanolin/petroleum jelly, olive oil or alcohol-based humectants such as glycerin.

• Consider the following nail lacquers: hydroxypropyl chitosan or HPCH, silicon containing nail hardeners made of silanediol salicylate and Pistacia lentiscus.^13,14

• Wear cotton gloves under occlusive gloves and minimize exposures to frequent dehydration.²

• For nail biters, consider sorbitol-based gum when sensing compulsions and apply bitter nail lacquer to help disassociate biting habits. Full consent and cooperation of the nail biter is necessary to quit nail biting.¹⁵

• Consider acetone-free nail polish remover (ethyl acetate, butyl acetate). After using nail polish remover, rinse and moisturize the nails to minimize nail thinning and brittleness.¹⁶

• Avoid or limit professional manicures, especially with gel or acrylic artificial nails.

PATIENT EDUCATION POINTS

• The underlying causes of nail fragility can be identified with the help of a dermatologist.

• Fragile nails can be difficult to completely reverse but with appropriate treatment and modified behavioral practices, improvement of nail health is possible.