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Brittle nail syndrome: Significant longitudinal ridging of the L1 and R1 fingernails in an otherwise healthy 77-year-old woman, consistent with onychorrhexis stage 3 ridging per grading criteria proposed by van de Kerkhof and colleagues. Courtesy of Amanda E Zubek, MD, PhD, FAAD.
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Brittle nail syndrome: Horizontal splitting of the free margin of the nail consistent with lamellar onychoschizia. Courtesy of Springer Healthcare (Dermatology and Therapy, 20 Nov 2019).
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Brittle nail syndrome: Moderate-to-significant longitudinal ridging of the R2-R5 fingernails in an otherwise healthy 77-year-old woman. Courtesy of Amanda E Zubek, MD, PhD, FAAD.
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Brittle nail syndrome: A 75-year-old woman with a history of hypothyroidism with moderate-to-severe longitudinal ridging of the L2-L4 fingernails consistent with onychorrhexis. Courtesy of Amanda E Zubek, MD, PhD, FAAD.
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Brittle nail syndrome: A 75-year-old woman with a history of hypothyroidism with moderate-to-severe longitudinal ridging of the R2-R4 fingernails, consistent with onychorrhexis. Courtesy of Amanda E Zubek, MD, PhD, FAAD.
Tables
Lamellar splitting defined as onychoschizia |
0 = None, clear of clinical signs of lamellar nail splitting |
1 = Mild, distal furrows, parallel to the back surface, not involving the entire free edge of the nail plate |
2 = Moderate, distal parallel furrows of the superficial nail plate involving the complete free edge of the nail plate |
3 = Severe, distal lamellar splitting of the complete free edge of the nail plate, lamellar splits covering at least one third of the nail plate |
Horizontal nail splitting from the free edge of the nail plate |
0 = None, clear of clinical signs from the free edge of the nail plate |
1 = Mild, one superficial horizontal split of the distal nail plate |
2 = Moderate, 2-3 horizontal splits of the distal nail plate |
3 = Severe, multiple horizontal splits leading to loosening of at least one third of the distal nail plate |
Assessment of ridges and longitudinal grooves |
0 = None, clear of any signs of ridging and longitudinal grooves |
1 = Mild, few plane ridges and longitudinal grooves |
2 = Moderate, few deep ridges and longitudinal grooves |
3 = Severe, more than 70% of the nail plate showing deep ridges and corresponding grooves |
Longitudinal splitting as derived from the nail matrix and defined as onychorrhexis |
0 = None, clear of clinical signs of longitudinal nail splitting |
1 = Mild, one single, superficial longitudinal split of the nail plate |
2 = Moderate, at least one deep longitudinal split of the entire nail plate |
3 = Severe, multiple, superficial and deep longitudinal splits of the nail plate |
