Brittle Nail

Aka: Brittle Nail, Nail Brittleness, Fragile Nail, Onychorrhexis, Lamellar Onychoschizia, Onychoschizia

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II. Epidemiology

  1. Prevalence: 20% of U.S, adults
  2. Most common in older women (esp. affecting Fingernails)

III. Findings

  1. Nails crumble, split or flake

IV. Types: Brittleness Patterns

  1. Background
    1. More than one pattern may coexist in the same nail
  2. Onychorrhexis
    1. Superficial longitudinal parallel furrows and fissures
  3. Lamellar Onychoschizia
    1. Splitting of the free margin of the distal nail, in horizontal layers
  4. Superficial keratin granulation
    1. Distal nail with fragile, small opaque white patches and striations

V. Causes

  1. Nail Trauma or Idiopathic (most common)
  2. Aging
    1. Associated with decreased nail lipid content, and nail plate Keratinocyte defects
  3. Secondary
    1. Inflammatory conditions (e.g. Psoriasis, Lichen Planus, Eczema)

VI. Management

  1. Treat underlying secondary causes
  2. May consider nail hardener

VII. References

  1. Chessa (2020) Dermatol Ther 10(1): 15-27 [PubMed]
  2. Leggit (2025) Am Fam Physician 112(4): 401-9 [PubMed]

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