What causes onychoschizia (nail splitting) and onychexis (nail peeling) of the toenails?

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Last updated: May 28, 2025View editorial policy

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From the Guidelines

Thin and peeling toenails are most commonly caused by fungal infections, such as onychomycosis, which can be triggered by factors like occlusive footwear, repeated nail trauma, genetic predisposition, and concurrent diseases like diabetes or immunosuppression, as noted in the British Association of Dermatologists' guidelines 1. When considering the management of thin and peeling toenails, it's crucial to address the underlying cause to improve morbidity, mortality, and quality of life.

  • Fungal infections (onychomycosis) are a primary cause, and treatment may involve oral antifungal medications or topical treatments.
  • Trauma-induced damage and nutritional deficiencies, such as biotin deficiency, can also contribute to the condition, with biotin supplementation showing promise in treating brittle nails (onychoschisis) 1. Key considerations for management include:
  • Protecting the nail from further trauma
  • Maintaining good foot hygiene
  • Keeping nails trimmed
  • Wearing properly fitting shoes
  • Avoiding prolonged moisture exposure
  • Considering biotin supplements for nutritional deficiencies, as supported by studies like 1, which highlight the role of biotin in treating brittle nails. Given the potential for various underlying causes, consulting a healthcare provider for a proper diagnosis is essential, as different causes require different treatments, and delaying treatment can impact quality of life and potentially lead to more severe complications.

From the Research

Causes of Thin and Peeling Toenails

  • Fungal infections, such as onychomycosis, can cause thin and peeling toenails 2
  • Dermatophyte infections, like Trichophyton rubrum, are a common cause of onychomycosis 2
  • Other factors, such as chronic and chronic relapsing tinea corporis, tinea cruris, and tinea faciei, can also contribute to thin and peeling toenails 3
  • The effectiveness of antifungal treatments, like terbinafine, itraconazole, and fluconazole, can vary in treating these conditions 3, 4
  • Limited research is available on the specific causes of thin and peeling toenails, but fungal infections and dermatophyte infections are known to be contributing factors 2, 3

Related Conditions

  • Onychomycosis is a fungal infection that can cause thin and peeling toenails 2
  • Tinea corporis, tinea cruris, and tinea faciei are conditions that can contribute to thin and peeling toenails 3
  • Vulvovaginal candidiasis is a yeast infection that can be treated with antifungal agents, but its relation to thin and peeling toenails is not directly established 4

Treatment Options

  • Antifungal treatments, like terbinafine and itraconazole, can be effective in treating fungal infections that cause thin and peeling toenails 2, 3
  • The effectiveness of these treatments can vary depending on the specific condition and the individual patient 3, 4

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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