Onychorrhexis

Abstract: Nail plate brittleness (or fragility) is a common complaint affecting up to 20% of the population, especially women over 50 years of age, with fingernail fragility being more prevalent than toenail fragility. Nail brittleness is characterized by nails that split, flake and crumble, become soft and lose elasticity. The main clinical presentations are: onychoschizia, onychorrhexis, superficial granulation of keratin and worn-down nails. According to causative factors, we can distinguish 2 forms of nail fragility (NF): a primary “idiopathic or brittle nail syndrome” form and NF secondary to different causes such as inflammatory nail disorders, infections, systemic diseases and general conditions, traumas and alteration of the nail hydration. Optimal management requires treatment of the primary cause of brittle nails, when possible. In idiopathic NF oral supplementation, vitamins (especially biotin, also known as vitamin B7), trace elements and amino acids (especially cysteine) have been reported to be useful. In addition, several products, such as topical moisturizers and lacquers could be considered to restructure the affected nail plate and to reduce psychological impacts of this common problem.

Abstract: Therapeutic benefits from aromatic retinoid have been described in the treatment of a variety of dermatological disorders. Stress is given on some of them which coexist with ungual abnormalities and the results are reported. These diseases include psoriasis, acropustulosis, keratosis lichenoides chronica. Drug-induced modifications of the epidermal structures of the nail apparatus are emphasized: fragility with onychorrhexis and onychoschizia is the commonest finding. Onychomadesis and nail shedding can be seen. Onycholysis is rare. Painful paronychia which is sometimes accompanied by granulation tissue and ingrowing nails is the most interesting alteration due to this synthetic retinoid and as yet unexplained.

Abstract: For reasons of clarity, definitions are offered for strength, hardness, flexibility, brittleness and toughness of the nails. Six clinical types of nail fragility are delineated: longitudinal furrows and splitting (onychorrhexis), single longitudinal splitting, multiple crenellated splitting, lamellar splitting (onychoschizia), transverse splitting and nail friability. Changes may be observed in the keratin structure of fragile nails. Nail brittleness is usually 'environmental' in origin, but sometimes may be part of a nail dystrophy. Household daily chores are particularly damaging. Among the acquired general causes, hypochromic anaemia and sideropaenia, arthritic deformities of the distal joints, peripheral vascular impairment and endocrinopathies are the best known. Useful therapeutic approaches are updated. They entail protection with plastic gloves worn over light cotton glove linings, the use of nail hardeners composed of two main types of products: a modified nail varnish that functions as a base coat or a hardener, such as dimethyl urea, which overcomes the objections related to formaldehyde; a systemic drug, biotine, is still useful.

Abstract: Summary Background The nail unit is an important part of cosmetic appearance of an individual. Older people are at an increased risk of nail alterations, including normal age-related changes and disorders that more commonly affect this specific population. Objectives To identify and evaluate the age-related nail changes and disorders in Egyptian elderly people both clinically and histopathologically. Patients/Methods A total of 400 adult subjects, not complaining from any dermatological disease, were included in the present study; half of them were elderly of 60 years and above (elderly group). Meanwhile, the other half served as a control group with younger ages. Full history taking, general and local examinations as well as nail biopsies were performed from selected cases with age-related nail changes and disorders. Results Nail changes were significantly (P < 0.05) more common in old age group (88%) compared to control subjects (39%). The commonest age-related nail changes noticed were pale, dull, opaque, and lusterless nails (73%); brittle nails (67.5%); decreased lunula visibility (49%); and onychorrhexis (45.5%). They showed highly significant increase (P < 0.001) when compared with control group. Conclusions The prevalence of nail changes and disorders has increased among elderly patients although they are frequently overlooked by health care providers. Dermatologist should be aware about various nail changes related to aging and those associated with other dermatoses or systemic diseases. Histopathologic picture can enhance the accuracy of clinical diagnosis of various nail changes and disorders.