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Toenail Disorders



Brittle nails are characterized by thin, inelastic nails which may split, flake or crumble. Brittleness of the nail is directly related to water content. Dermatologic or systemic diseases, nutritional deficiencies or certain drugs may produce nail plate dehydration. Little evidence exists to support the use of vitamin supplementation with vitamin E, vitamin C, vitamin A, retinoids, retinol, retinal, silicon, zinc, iron, copper, selenium, or vitamin B12 in healthy patients with brittle nails. Biotin is the only vitamin that has demonstrated effectiveness in the treatment of brittle nails. Neither calcium nor gelatin will help strengthen nails.

Brittle nails are most commonly due to dryness and surprisingly, dryness of the nail plate is associated with excess exposure to moisture. Nails can absorb about 25% of their weight in water and the nails expand when they absorb water and contract when they dry. This process weakness the nails.Toenail Anatomy picture labeled

Treating brittle nails: To treat dry, brittle nails place a thick, moisturizing cream on the nails after you shower. This will help lock in moisture. Look for products which contain urea, lanolin and/or alpha-hydroxy acid. Don't soak your feet for longer than 10-15 minutes because this is dry out the nails and the skin.

Flat or Spoon Shaped Nails: Also called koilonychia, the nails become thin and lose their shape. Can be due to Plummer-Vinson syndrome, iron deficiency anemia or hyperthyroidism.

Clubbing of the Nails: Softening and widening of the nail along with an increase in the convex shape of the nail. Clubbing can represent diseases of the heart or lungs, such as COPD, lung CA or subacute bacterial endocarditis. Hypertrophic pulmonary osteodystrophy can occur in response to new bone formation under the nail.

Yellow nails: Yellow thick nails may be a sign of a fungal nail infection, but lung diseases, such as pleural effusions or brochiectasis or chornic sinusitis or lymphadema may also cause yellow nails.

Black Discoloration: A black discoloration of the nails can be a subungual hematoma, or blood under the nails from trauma or microtrauma. When blood is under the nails, the dark discoloration will migrate to the tip of the nail over time as the nail grows. A main concern of black, brown or dark discolorations under the nails is melanoma. Vitamin B12 deficiency can also cause this type of discoloration.

White spots on Nails: Patchy white areas near the tip of the toenail may be a fungal nail infection. Repetitive microtrauma can cause the nail plate to separate from the nail bed resulting in white spots on the nail.

Abnormally Thick Nails: Thick nails generally occur from repetitive microtrauma, called pachyonychia, but can be the result of a rare genetic disorder called Jadassohn-Lewandowski Syndrome which results in excess keratin formation.




last updated 5/22/15

Disclaimer: The advice on this website is not intended to substitute for a visit to your health care provider. We will not be held liable for any diagnosis made or treatment recommended. Consult your doctor if you feel you have a medical problem.