Brittle nails (onychoschizia and onychorrhexis)

Brittle nails are a very frequent problem in which the nails lose part of their resistance and become fragile, breaking, flaking or cracking easily. Although on many occasions it is a purely cosmetic problem, on others it can be the first sign of a skin disease or a general medical problem.

There are two main forms. Onychoschizia is the separation of the layers of the nail, which flakes in laminae, especially at the free edge. Onychorrhexis is the appearance of longitudinal grooves and fissures that run along the nail from the base to the tip. Both can coexist in the same person.

The causes are very varied.

Aging. Over the years, the nails lose part of their hydration and elasticity, so the fragility increases progressively.

Repeated contact with water and chemical products. It is one of the most frequent causes. The repeated contact with water, soaps, detergents, cleaning products and solvents favors the dehydration of the nail.

Repeated trauma. Very frequent manicures, the aggressive removal of semi-permanent polish, gel or acrylic nails, the continued use of acetone and repeated microtrauma can also influence.

Nutritional deficiencies. In some patients they can be associated with a deficiency of iron, zinc, proteins or B-group vitamins. These situations are less frequent than usually believed.

Diseases. Brittle nails can also appear in patients with psoriasis, atopic dermatitis, lichen planus, thyroid alterations, systemic diseases and some fungal infections.

The most usual symptoms are nails that break easily, flaking in layers, longitudinal cracks, irregular edges, difficulty in growing the nails and a feeling of thin and weak nails. They generally do not produce pain, except when the fissures reach deeper layers.

The diagnosis begins with a detailed clinical history. The doctor will assess the time of evolution, the profession, manicure habits, contact with water or chemical products, usual medication and associated diseases. Afterwards, they will perform an examination of the nails and the skin.

When there are diagnostic doubts, blood tests, a microbiological study if a fungal infection is suspected or other specific tests according to each case may be requested.

Treatment depends on the cause.

Protection of the nails. It is the most important measure. It is recommended to use gloves for household tasks, avoid prolonged contact with water and reduce the use of chemical products.

Hydration. The daily application of moisturizing products helps to improve the elasticity of the nail. Creams containing urea, glycerin, lactic acid or ceramides are especially useful. Specific oils for nails and cuticles can also be used.

Treat the underlying disease. When there is a responsible disease, it should be treated specifically, as in psoriasis, lichen planus, onychomycosis or thyroid alterations.

Correct nutritional deficiencies. Only when they are demonstrated through a medical evaluation. Taking supplements systematically is not recommended.

Keep the nails short while they recover, file the edges gently, avoid using the nails as a tool, use gloves during household tasks, moisturize nails and cuticles daily, limit the use of acetone-based nail polish removers and space out aggressive manicures.

You should consult if the nails break persistently, if only one nail is affected, if color changes appear, if the nail detaches from the finger, if there is pain, if inflammation appears around the nail or if the alterations also affect the hair or the skin.

• Myth: Brittle nails always mean a lack of calcium. Fact: No. Calcium deficiency is rarely the cause.
• Myth: Gelatin strengthens the nails. Fact: There is no solid scientific evidence demonstrating this effect.
• Myth: Biotin strengthens all nails. Fact: It only seems to be useful in some selected patients. It is not a universal treatment.
• Myth: The nails need to "breathe". Fact: The nails are formed by keratin and do not breathe. However, it is advisable to take breaks between manicures to avoid repeated aggressions.
• Myth: Polish always damages the nails. Fact: The problem is usually more related to the aggressive removal of the polish than to the polish itself.

• Brittle nails are a very frequent and usually benign problem.
• The most common cause is the repeated aggression by water, chemical products and manicures.
• They can also be related to skin or systemic diseases.
• Treatment consists of protecting the nails, moisturizing them and correcting the cause when it exists.
• Supplements are only useful when there is a demonstrated deficiency.
• In the face of persistent changes or involvement of a single nail, it is advisable to consult a specialized doctor.