Current Management of Brittle Nails

Dana Stern discusses the current management of brittle nails, addressing a common dermatological concern that affects an estimated 30% of women over 50 and about 20% of the general population. She defines brittle nails as prone to splitting, breaking, and peeling, often characterized by onychoschizia (horizontal layering) and onychorexis (longitudinal ridges). Stern explains the nail's physiology, detailing its composition and highlights that brittle nails are primarily due to abnormalities in keratin, keratin-associated proteins, and lipid content—not water levels, which have been overstated in previous studies. She emphasizes distinguishing intrinsic factors (genetics, aging) which are harder to modify, from extrinsic factors (environmental influences like harsh chemicals, nail treatments, and hygiene habits) that offer opportunities for intervention. Stern offers practical advice for patients, such as keeping nails short, using protective gloves during wet work, avoiding certain harsh products, and recommending specific dietary or topical strategies rich in beneficial compounds. She concludes that while brittle nails pose a challenge for patients and dermatologists alike, taking a thorough history and focusing on modifying extrinsic factors can greatly improve nail health.