Onychorrhexis is a disease of the nails which is visible in the form of clear changes. The disease is associated with the hardening and fragility of the nails, resulting in cracking and furrows. The reason for the Onychorrhexis is quite varied. The cause of the disease is mainly physical. The cause may be nail biting, the strong smell of nail polish remover, etc. When the nails are injured on a number of occasions, there is damage to the structure of the nails, which causes the fragility of the nails, and make them more prone to cracking and deformation.
Nutritional deficiency is also a contributing factor. Our diet provides us with essential nutrients that are necessary for the maintenance of nail health. A deficiency in biotin, a type of B vitamin, has been shown to cause thinning and weakening of the nails. Biotin is important for the growth of strong and thick nails. As concluded by studies conducted by Chessa et al. ( 2020), people with biotin deficiency tend to suffer from onychorrhexis. Hence, it is very important to have a proper diet to support our nail health.
There are several different causes of onychorrhexis. Some of the causes are related to the physical and nutritional status of the nail, whereas other causes are related to other health conditions. Problems with the thyroid gland (endocrine system) and psoriasis and other systemic conditions can cause changes to the nails. This affects the nail plate as it grows out, causing the brittleness and texture changes seen in onychorrhexis. Wollina et al. ( 2016) comment on the relationship of the nails to health in general, and how any changes to the nails indicate other conditions that may also need to be evaluated.
The clinical manifestation of onychorrhexis is relatively easy to detect. The nails are slender, brittle and rough, accompanied by transverse grooves or ridges. Onychorrhexis leads to nail split and structural deformation, and makes it difficult to manage. All these factors will have an adverse effect on the physical appearance of the nails. Patients with onychorrhexis may experience feelings of shame towards their condition.
The psychosocial impact of onychorrhexis can also not be dismissed. A nail condition such as onychorrhexis which is noticeable can result in the individual with nail changes feeling inferior to others, and that they are not as attractive as others. The self esteem can be negatively affected. As Harrison and Bergfeld (2009) point out, “some people find themselves being looked at or judged because of their nails, and find themselves embarrassed and lacking in personal confidence. Social interactions may be avoided or the individual may have low self-esteem, due to perceived changed appearance.” Hence, the emotional and psychological effects of having a noticeable nail condition like onychorrhexis can also affect an individual’s social and psychological well-being.
Onychorrhexis is a multifactorial disorder resulting from trauma, malnutrition, and systemic disease. It also has a cosmetic and psychological impact impacting nail care. To treat onychorrhexis, both topical and systemic treatments can be used. Moisturizing creams and lotions are commonly used for nail and cuticle care. Hydration to the nail plate is crucial in order to restore nail health. As mentioned by Lipner & Scher (2018), creams that have urea and alpha hydroxy acids in them can help to moisturize and soften the nail plate allowing for strengthening of the nail plate. These creams can help to strengthen the nail and decrease brittleness which is a common characteristic of onychorrhexis.
The effect of topicals alone is clearly disputed. Hence it is also important to consider and discuss potential systemic contributing factors to nail growth. Often discussed in relation to nail growth is the vitamin, biotin, also known as vitamin B7. Biotin is involved in the synthesis of keratin which is a type of protein that helps to make up nails. As shown by a number of investigations; including one mentioned in Baboun et al. ( 2024), using biotin and therefore increasing the body’s biotin levels can promote healthier nails, with effects that typically include the enhancement of nail thickness, while also causing a reduction in the splitting of the nail. Indeed, whereas people may experience slightly different levels of benefits from taking biotin, generally, biotin supplementation to the nails is thought to be both safe and inexpensive.
There are many natural treatments and options that people are looking into to help keep their nails healthy. Using oils on your nails can actually be very helpful. Coconut oil and olive oil can help moisturize the nails so that they are less likely to crack and break. Applying oils can also become a part of your regular nail care routine, and helping to keep your nails healthy and onychorrhexis-free. Eating the right vitamins and minerals is also important for maintaining healthy nails, with zinc and iron being two examples of nutrients that may be important to your nail health. Ensuring that you have a balanced diet will help to ensure healthy nails.
Nail care is also important. As mentioned previously, Watkins (2015) highlighted the importance of having a consistent nail care regime. Trimming, filing and avoiding exposure to nail drying chemicals found in items such as detergents and washing up liquid is advised. Wearing gloves for cleaning and washing up can also help to improve the state of the nails.
While genetic and other biological factors play a role in nail health, environmental factors also make a huge impact to nail health, as mentioned by Lee & Lipner (2022). Exposure to water frequently, using too much detergent, or having excessive exposure to chemicals can all cause damage to nails. Many jobs in which workers are required to be constantly on their feet, and are therefore more frequently exposed to the hazards listed above, may also experience dry, brittle nails that tend to split and chip. Addressing and alleviating these environmental factors may greatly benefit nail health.
Also important is to look for underlying health issues that may have contributed to the development of the nail condition. Conditions that may be more common in individuals with onychorrhexis include hypothyroidism, psoriasis and iron deficiency. Piraccini (2019) noted that successful management of the underlying condition had a dramatic impact on the patient’s nail condition. Holzberg & Baran (2012) agree, adding that the best management of the nail condition occurs when a comprehensive approach is taken to determine if there are any underlying systemic health issues.
Combining topical and systemic treatments with proper nail care and awareness of the role of environmental factors in the disease can bring about a dramatic improvement in the health of the nails of a patient with onychorrhexis. Identifying and treating underlying conditions can provide the best possible benefits for affected patients, significantly improving their overall quality of life.
Citations:
Chessa, M.A., Iorizzo, M., Richert, B., López-Estebaranz, J.L., Rigopoulos, D., Tosti, A., Gupta, A.K., Di Chiacchio, N., Di Chiacchio, N.G., Rubin, A.I. and Baran, R., 2020. Pathogenesis, clinical signs and treatment recommendations in brittle nails: a review. Dermatology and therapy, 10(1), pp.15-27. https://link.springer.com/article/10.1007/s13555-019-00338-x
Wollina, U., Nenoff, P., Haroske, G. and Haenssle, H.A., 2016. The diagnosis and treatment of nail disorders. Deutsches Ärzteblatt International, 113(29-30), p.509. https://pmc.ncbi.nlm.nih.gov/articles/PMC5527843/
Watkins, J., 2015. Diagnosing and treating nail trauma. Practice Nursing, 26(1), pp.27-31. https://www.magonlinelibrary.com/doi/full/10.12968/pnur.2015.26.1.27
Lee, D.K. and Lipner, S.R., 2022. Optimal diagnosis and management of common nail disorders. Annals of Medicine, 54(1), pp.694-712. https://www.tandfonline.com/doi/abs/10.1080/07853890.2022.2044511
Richert, B. and Andre, J., 2011. Nail disorders in children: diagnosis and management. American journal of clinical dermatology, 12(2), pp.101-112. https://link.springer.com/article/10.2165/11537110-000000000-00000
Lipner, S.R. and Scher, R.K., 2018. Biotin for the treatment of nail disease: what is the evidence?. Journal of Dermatological Treatment, 29(4), pp.411-414. https://www.tandfonline.com/doi/abs/10.1080/09546634.2017.1395799
Piraccini, B.M., 2019. Drug‐induced nail disorders. Baran & Dawber’s Diseases of the Nails and their Management, pp.574-603. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119323396.ch16
Holzberg, M. and Baran, R., 2012. The nail in dermatological disease. Baran & Dawber’s Diseases of the Nails and their Management, pp.257-314. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118286715.ch6
Harrison, S. and Bergfeld, W.F., 2009. Diseases of the hair and nails. Medical Clinics, 93(6), pp.1195-1209. https://www.medical.theclinics.com/article/S0025-7125(09)00105-9/abstract
Baboun, D., Yaghi, M., Keri, J.E. and Morrison, B.W., 2024. Natural Treatment Options for Nail Disorders. Skin appendage disorders, 10(2), pp.83-91. https://karger.com/sad/article/10/2/83/870533
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