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DocSpot: Nail problems

Dear Dr Margaret
My nails are shedding in layers, and they also seem too soft. Do I need something added to my diet? I am mainly vegetarian – I eat chicken once a month and no other animal products.

The usual cause of this problem is repeated wetting and drying of the nails. You may have noticed that your nails absorb water and swell slightly when wet, and then shrink slightly as they dry. Repeated wetting and drying makes the nails expand and contract many times, which weakens the protein bridges between the cells of the nail. The result is that the nail separates into layers at its outer free edge. The damage can be made worse by nail-biting, by everyday activities such as typing, and by chemicals (such as detergents and harsh nail-polish removers).
Your nails should improve if you wear rubber gloves for wet household chores. Keep the nails short to avoid accidental damage to them, but trim them only when they are well hydrated. Hydrating the nails before bedtime may help. To do this, soak your nails in warm water for 15–20 minutes. After drying them gently, apply plenty of moisturizer, such as nail cream or yellow soft paraffin (which you can also buy from pharmacies). Then wear cotton gloves overnight.
I do not know of any evidence that changing your diet will help. Similarly, supplements such as calcium or other minerals, gelatine and herbal preparations are heavily advertised for this problem, but I know of no scientific evidence in favour. The only exception is biotin, a B vitamin, which you can buy from health-food stores. Several studies in the 1990s suggested that taking 2.5 mg of biotin daily for several months improves the thickness and strength of nails. However, the studies involved only small numbers of people and not all of them improved. It appears to be a safe vitamin, but a 2.5 mg dose is actually a mega-dose (i.e. much greater than you would normally take in your diet), so perhaps one should be slightly cautious.
Dear Dr Margaret
My nails have grooves and ridges. Is it a sign of disease?

Ridges and grooves in the nails – lengthways or crossways – may be unsightly, but are nothing to worry about. I do not know your age, but as we get older, it is normal for the nails to develop ridges along the length of the nail. Concealment with a ridge-filling nail polish is the only remedy.
A crosswise groove results from a temporary pause in the growth of the nail, which often happens during a severe illness. Nails grow from the base, at a rate of about 1 mm/week, so a groove across the middle of the nail reflects poor growth several weeks previously. If you have several crosswise grooves you may be repeatedly damaging the base of the nail. The usual cause is a nervous habit of constantly pushing back the cuticle with the thumbnail of the same hand. Breaking this habit will allow the ridges to grow out.

Sources of information

Colombo VE, Gerber F, Bronhofer M, Floersheim GL. Treatment of brittle fingernails and onychoschizia with biotin: scanning electron microscopy. Journal of the American Academy of Dermatology 1990;23:1127–32.
De Berker D. Nails. Medicine;2004:32(12):32–5.
Hochman LG, Scher RK, Meyerson MS. Brittle nails: response to daily biotin supplementation. Cutis 1993;51:303–5.
Scher RK, Fleckman P, Tulumbas B et al. Brittle nail syndrome: treatment options and the role of the nurse. Dermatology Nursing 2003;15:15–23.
van de Kerkhof PC, Pasch MC, Scher RK et al. Brittle nail syndrome: a pathogenesis-based approach with a proposed grading system. Journal of the American Academy of Dermatology 2005;53:644–51.

Last updated; Sunday, August 30th 2020

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