What is the possible cause of onychoschizia (nail splitting)?

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Differential Diagnosis for Vertical Nail Splitting

  • Single most likely diagnosis
    • Onychorrhexis: This is the most common cause of vertical nail splitting, often due to aging, nail trauma, or exposure to harsh chemicals, leading to brittle nails that are prone to splitting.
  • Other Likely diagnoses
    • Nail psoriasis: This condition can cause nail changes, including vertical splitting, due to inflammation and thickening of the nail plate.
    • Fungal nail infections (onychomycosis): Fungal infections can weaken the nail, leading to splitting and brittleness.
    • Nutritional deficiencies (e.g., biotin, vitamin B7 deficiency): Deficiencies in certain nutrients can affect nail health, leading to brittle nails that are more prone to splitting.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Thyroid disorders (e.g., hypothyroidism): Although less common, thyroid disorders can cause nail changes, including vertical splitting, and it is crucial to rule out these conditions due to their potential impact on overall health.
    • Systemic lupus erythematosus (SLE): This autoimmune disorder can cause a range of symptoms, including nail changes, and early diagnosis is essential to prevent long-term complications.
  • Rare diagnoses
    • Lichen planus: This rare autoimmune disorder can cause nail changes, including vertical splitting, although it is less common than other causes.
    • Darier's disease: A rare genetic disorder that can affect the nails, causing changes such as vertical splitting, although it is extremely uncommon.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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