Medication Summary
Medical therapy should be strongly considered when brittle nail syndrome is suspected to have developed secondary to an underlying systemic or dermatologic disease. Otherwise, the level of medical therapy is guided by the desires of the patient and impact on quality of life.
B Vitamins
Class Summary
Biotin supplementation may help to treat brittle nails.
Biotin (Appearex, Coenzyme R, Nail-ex)
Biotin may promote nail growth by aiding in the metabolism of amino acids responsible for building proteins associated with nail growth. It is known to function as a coenzyme of metabolic processes.
Dermatologics, Other
Poly-ureaurethane (Nuvail)
Poly-ureaurethane is a biocompatible, polymeric solution that forms a uniform film when applied to the nail; it adheres to the nail surface, preventing direct abrasion and friction on the nail surface; it also provides protection against moisture.
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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 |
