Figure

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Distal nail fissure.

Home Remedy For Internal Fissure

Figure 6.2

Distal nail fragility. Crenellated distal splitting associated with distal

Figure 6.2

Distal nail fragility. Crenellated distal splitting associated with distal

A text atlas of nail disorders 168 onycho-schizia (splitting into layers).

Hapalonychia Eggshell Nail

Figure 6.3

Surface nail fragility and fractures due to nail varnish (keratin granulations).

Figure 6.3

Surface nail fragility and fractures due to nail varnish (keratin granulations).

Eggshell Nail Disorder

Figure 6.4

Nail fragility in lichen planus. (ridging, splitting and onychoschizia).

Figure 6.4

Nail fragility in lichen planus. (ridging, splitting and onychoschizia).

Lamellar Onychoschizia

Figure 6.5

Severe nail plate fragility after etretinate therapy before loss.

Figure 6.5

Severe nail plate fragility after etretinate therapy before loss.

Amyloidosis Nail

Figure 6.6

Nail apparatus—amyloidosis.

Figure 6.6

Nail apparatus—amyloidosis.

Amyloidosis Pictures

Figure 6.7

Darier's disease, with some nail plate loss.

Figure 6.7

Darier's disease, with some nail plate loss.

• thin nail plate of any cause

• occupational disease (for example working with industrial oils)

• chronic arthritis

hypothyroidism

• peripheral ischaemia

• peripheral neuritis

• hemiplegia

• cachexic states.

In some cases of hapalonychia the thinned nails assumed a semi-transparent, bluish-white hue, sometimes described as 'eggshell nails'. Nail fragility syndrome can be divided into six main types on morphological grounds:

1 An isolated longitudinal split at the free edge which sometimes extends proximally.

2 This may result from onychorrhexis with shallow parallel furrows running on the superficial layer of the nail.

3 Multiple, crenellated splitting which resembles the battlements of a castle. Triangular pieces may easily be torn from the free margin.

4 Lamellar splitting of the free edge of the nail into horizontal fine layers (onychoschizia) (see Figures 3.39, 3.43). This may occur alone or associated with the other types.

5 Transverse splitting and breaking of the lateral edge close to the distal margin.

6 Nail friability is observed in psoriasis, onychomycosis and as adverse effect of nail varnish (keratin granulations, figure 6.3).

The changes in brittle, friable nails are often confined to the surface of the nail plate; this occurs in superficial white onychomycosis and may be seen after the application of nail polish or base coat which causes 'granulations' in the nail keratin. In advanced psoriasis and fungal infection the friability may extend throughout the entire nail.

The changes in nail consistency may be due to impairment of one or more of the factors on which the health of the nail depends, for example variations in the water content or keratin structure and corneocyte adhesion. In addition, changes in the intercellular structures and cell membranes, and intracellular changes in the arrangement of keratin fibrils, have been revealed by electron microscopy. Normal nails contain approximately 18% water. After prolonged immersion in water this percentage is increased and the nail becomes soft; this makes toe-nail trimming and nail biopsies much easier. A low lipid content may decrease the nail's ability to retain water. If the water content is considerably reduced, the nail becomes brittle. Splitting, which results from this brittle quality, is probably partly due to repeated uptake and rapid drying out.

The keratin content may be modified by chemical and physical insults, especially in occupational nail disorders. Amino acid chains may be broken or distorted by alkalis, oxidizing agents and thioglycollates (used in the permanent waving of hair). These break or distort the multiple disulphide bond linkages which join

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