Eggshell Nails (Brittle Nail Syndrome): Causes, Features, and Management

Clinical Features

• Thin, fragile nails that split, peel, break easily
• White/yellow discoloration, longitudinal ridging
• Soft, flexible nail plate

Etiologies

• Nutritional: Biotin, iron, zinc, protein deficiency.
• Systemic disease: Hypo/hyperthyroidism, anemia, psoriasis, lichen planus, Raynaud's.
• Medications: Chemotherapy, retinoids, some antibiotics.
• Environmental/Behavioral: Frequent wet work, solvents, nail trauma (biting, picking), excessive manicures.
• Aging: Reduced nail matrix turnover.

Management

1. Diagnose and treat underlying cause.
2. Biotin 2.5–5 mg/day (evidence for brittle nails).
3. Protective measures: gloves for wet work, avoid harsh chemicals.
4. Moisturize nails/cuticles (urea, lactic acid, oils).
5. Nail hardeners (formaldehyde-free) if needed.
6. Gentle filing; avoid acetone removers.

Severe or refractory cases may need dermatology referral for systemic evaluation.