General factors

Aging (fingers) Anaemia (iron deficiency) Cachexic state

Chronic arthropathies (fingers or toes) Drugs

Antimetabolites Arsenic

Acitretine (etretinate) Gold salts

Penicillamine

Vitamin A, C and B6 deficiencies Gout

Graft-versus-host disease

Haemodialysis

Hyper- or hypothyroidism

Neurological

Hemiplegia

Neuropathies

Osteomalacia

Osteoporosis

Peripheral circulatory impairment (arterial) Pregnancy

Sulphur deficiency diseases_

the protein chains to form the keratin fibrils. Keratin structure can also be changed in genetic disorders such as dyskeratosis congenita, in which the nail plate is completely absent or reduced to thin, dystrophic remnants. The composition of the nail plate is sometimes related to generalized disease. A high sulphur content, predominantly in the form of cystine, contributes to the stability of the fibrous protein by the formation of disulphide bonds. A lack of iron can result in softening of the nail and koilonychia; conversely, the calcium content of the nail appears to contribute little towards its hardness. Age-dependant decrease in cholesterol sulfate levels might explain the higher incidence of brittle nails in women. Calcium is located mainly in the surface of the nail, in small absorbed quantities, and X-ray diffraction shows no evidence of calcite or apatite crystals.

Damage to either the central or the peripheral nervous system may result in nail fragility.

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