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Key Phrases April 2006
Brittle nails are a common reason why patients consult a dermatologist. The incidence of brittle nails in the European and North American population is approximately 20%, and women suffer from nail brittleness twice as often as men (1). There is no concise definition of what constitutes a brittle nail, and there are no characteristic histological findings to help the clinician make this diagnosis. The dermatologist needs to make the diagnosis of brittle nails based on the patient's history and certain non-pathognomonic clinical features. The presenting complaints of patients with brittle nails are often their inability to grow long nails and a description of their nails as soft, dry, weak, or easily breakable. More objective clinical features seen in brittle nails are onychoschizia (transverse splitting), onychorrhexis (longitudinal splitting), and nail plate surface degranulation (2). Brittle nails have been divided into several types including an isolated split at the free edge, lamellar splitting of the free edge, transverse splitting of the lateral edge, and multiple crenellated splitting that resembles the battlements of a castle (3). Most commonly, a clear-cut etiology for brittle nails cannot be found and hence most cases are labeled as "idiopathic brittleness of the nails." Dehydration due to external influences such as water, detergents, or dehydrating chemicals is often a contributing or causative factor (4). These agents decrease the normal water content of the nail plate, which then results in breakage of the intercellular corneocyte bridges, leading to a fragile and brittle nail plate. Similarly, evaporation of water in the nail plate due to high and low temperatures can result in identical changes (5). Quantitative and qualitative changes in nail keratins may also be induced by chemical and physical insults. Hapalonychia (thinning of the nail plate) due to decrease of the nail matrix length may predispose towards the development of brittle nails. Nails also become more brittle with age. This may be due to the decreased nail growth rates observed in elderly individuals and thus an inherent increased exposure time of the nail plate to environmental factors. Likewise, as skin is drier in the elderly, so too are the nails. A genetic component in the etiology of brittle nails is suggested by the fact that approximately half of patients will report a family member with similar complaints. |
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