Dr. Rob

Q: I am concerned that the conditions of my fingernails may indicate that there is something wrong with my health (my toenails are fine). I have never had a problem with them before, but now they are splitting and cracking. What could this be caused from?

A: Sounds like your fingernails may have a condition called onychoschizia. This is pretty common and can cause splitting, fragile, thin or soft nails. Since only your fingernails are affected, the cause of your onychoschizia is probably from an external factor, such as repeated wetting of the nails. If you had a vitamin deficiency or internal health condition, both finger- and toenails would usually be affected. To make sure, please get them checked by your family physician or dermatologist because this type of visual diagnosis needs to be done in person.

In evaluating your nails, your healthcare professional will most likely mention they are made from a protein known as keratin, and their strength, growth rate and thickness are determined by genetics.  In determining nail health, the following need to be examined:

  • Nail plate, which is what we see.
  • Nail bed, which is what the nail sits upon.
  • Nail folds, which are grooves in the skin where the nail plate sits.
  • Cuticle, which is a thin layer of skin overlying the base of the nail.
  • Matrix, which is the area of nail growth just under the skin at the base of the nail.

During this exam it is important to look at both your finger as well as toenails. Many simple problems (splitting, fungal) usually affect either finger or toenails (sometimes both), while more significant health issues (lung disease, heart valve infection) are often simultaneously located in both areas. Clues which hint to a nail and/or body health issue include but aren’t limited to:

  • Discoloration, possibly due to medications (anti-malarial drugs), nicotine from cigarette smoking, or even from hair-coloring products. Please note that nails should normally be white near the base of the nail and pink over the rest of the nail.
  • Thickened, which may be due to psoriasis or a fungal infection.
  • Bacterial infection, often caused from repeated biting of nails, a complication of severe eczema or chronic wet hands. Green-appearing nails can result from the bacterium pseudomonas.
  • Splitting, usually due to nails being exposed to chemicals, repeated wet and dry conditions or trauma.
  • Ridged, caused by rheumatoid arthritis, fever, illness, age changes, eczema or damage to the nail matrix.
  • Raised nail plate, from psoriasis, exposure to chemicals such as formalin or a fungal infection.
  • Red streaks in the nail bed, may be due to a heart valve infection.
  • Horizontal depressions, which could be a sign of a severe illness.
  • Clubbing, where the nail looks like it is in the shape of a spoon, may indicate lung or heart disease.
  • Dull color or brittle nails often tied to vitamin deficiency.
  • Aging, as we get on in years our nails tend to get more brittle and split.

Getting back to your specific concern, onychoschizia can usually be traced to one of these three reasons: repetitive and prolonged wetting and drying of the nails; damage from chemicals such as detergents, cleaning fluids and nail polish remover; or from trauma to the nails, such as biting, injuries, etc.. Fortunately, there are good treatment strategies available to reverse the damaging affects from these activities. These include:

  • Wearing cotton-lined rubber gloves when having prolonged exposure to wet conditions or exposure to cleaning products.
  • Never peeling or scraping nail polish off the nails.
  • Stop biting the nails or using them as tools, like picking teeth.
  • Not using metal instruments to push back the cuticles. Sometimes this action also scrapes the nail surface.
  • Keeping the nails short and shaped with rounded tips if you partake in activities that can traumatize the nails, such as certain sports, jobs, etc.
  • Minimizing the use of nail polish remover as it can dry out the nails and leave them more prone to cracking.

Summing up, with the help of lifestyle changes (no more nail biting), your nail problem sounds like it can be helped. However, to nail down a proper diagnosis and treatment plan, please visit your healthcare professional.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)

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