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Nails'Beau's Lines/Onychorrhexis
Published in Charles Theisler, Adjuvant Medical Care, 2023
Beau's lines are horizontal (transverse) white bands comprised of depressions, or indentations, in the nail plate. They run parallel to the white, moon-shaped portion of the nail bed (lunula) seen at the nail's origin. The lines, or ridges, grow out with the nails. Causes can include trauma, pemphigus, chronic infection, malignancy, malnutrition, collagen disease, and Raynaud's disease. Trauma typically affects one or two nails. Systemic illnesses can affect all 20 nails.1 Onychorrhexis causes longitudinal ridges to form on thin brittle nails. The cause can be medical (e.g., arteriosclerosis, thyroid disease, lack of iron, folic acid, protein, etc.)2 or environmental (e.g., strong soaps, water exposure, nail polish remover, etc.). If the cause is a deficiency or medical condition, then both fingernails and toenails should be affected. Otherwise, consider environmental factors.
Leg, foot and nail disease in the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
M. Alam, R. K. Scher, P. I. Schneiderman
Aging causes a reduction in the linear growth rate of the nail89–92. The rate declines steadily from the second decade, and by the end of life is decreased by about 40%. Significantly, the treatment duration for onychomycosis may be correspondingly lengthened in the elderly since treatment efficacy is related to the replacement of infected nail plate by newly produced nail. In addition to growing more slowly, the nail in the elderly is more prone to splitting, fissuring and developing superficial longitudinal furrows, or onychorrhexis95–95. Cosmetic improvement of onychorrhexis may be achieved by buffing the nail regularly with a gently abrasive powder, paste, or cream formulation96,97. Fingernails tend to soften with age, and toenails to become thicker and more rigid98. Pachyonychia, generalized thickening of the nail, may be improved by buffing, or, in severe cases, by chemically or mechanically mediated nail avulsion99–108. Intractable cases may require nail matrix destruction. Before an elderly individual is subjected to even a minor surgical procedure, a thorough preoperative assessment of surgical risk should be obtained109.
Brittle Nails
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
In fact, distinctive clinical features of brittle nail syndrome are onychoschizia and onychorrhexis, and they reflect its pathogenesis. Impaired intercellular adhesive factors of the nail plate are expressed clinically as onychoschizia, showing lamellar splitting of the free edge and distal portion of the nail plate (Figure 3.1). Onychorrhexis reflects matrix involvement and is characterized by longitudinal thinning or ridging of the nail plate with distal splitting (Figure 3.2). Other findings such as horizontal splitting and breaking of the lateral edges have also been described. Granulations in the nail keratin may take place when brittle nail changes are confined to the surface of the nail plate. Patients often complain that their nails are dry, soft, easily breakable, and incapable of growing long.
Optimal diagnosis and management of common nail disorders
Published in Annals of Medicine, 2022
Clinically, there are three types of nail fragility: lamellar onychoschizia, onychorrhexis and superficial granulation of keratin. Lamellar onychoschizia, also known as lamellar dystrophy, is characterized by the presence of fine horizontal layers that crack and peel easily from the free margin (Figure 1(A)). Impaired intercellular adhesion of the nail plate is thought to contribute to this condition [2,3,6]. This form of nail fragility is common in patients who wash their hands excessively (e.g. healthcare workers and homemakers) and those with lichen planus [3,5]. Onychorrhexis is defined as longitudinal splitting and fissuring of the superficial nail plate (Figure 1(B)). It is often seen among the elderly and in conjunction with onychoschizia. Its clinical presentation depends on the severity and degree of involvement of the nail matrix. It may result from an isolated split at the free edge of the nail plate that extends proximally [3]. Superficial granulation of keratin presents in the distal nail plate. It is characterized by white-yellow discolouration and striations. The keratins in the nail plate undergo an exfoliative process resulting in formation of patches. This condition is most commonly reported in patients who wear nail varnish often [3,5].
Focussing on the foot in psoriatic arthritis: pathology and management options
Published in Expert Review of Clinical Immunology, 2018
Aimie Patience, Philip S. Helliwell, Heidi J. Siddle
Nail disease in PsA (Figure 1) can be divided into changes arising from the nail matrix and changes involving the nail bed. Typical nail matrix disease includes leukonychia (white discoloration), onychorrhexis (nail ridging), nail pitting, and blood spots on the lunula whereas nail bed disease can present as onycholysis (separation of the nail from the nail bed) (Figure 2), splinter hemorrhages, and subungual hyperkeratosis [9]. There are a number of scoring systems to assess the extent of nail disease including the Nail Psoriasis Severity Index and the Psoriasis Nail Severity Score [14,15] but it is often difficult to differentiate from bacterial and fungal infections which can mimic the presentation of psoriatic nail disease.
Biotin for the treatment of nail disease: what is the evidence?
Published in Journal of Dermatological Treatment, 2018
Shari R. Lipner, Richard K. Scher
Brittle nails are characterized by signs of nail plate fragility and splitting. This condition affects 20% of the population with women affected more often than men. It is not merely a cosmetic problem, as patients may have sensitivity and have problems performing daily living activities (29). Brittle nails are clinically diagnosed by onychorrhexis (longitudinal fissures) and onychoschizia (nail peeling; Figure 2) (30). Pathogenesis is likely due to faulty intercellular adhesion of corneocytes and as well as pathologic nail formation. Treatment includes avoidance of irritants, limiting water immersion, and emollients (29).