From the Guidelines
Horizontal nail splitting in a 70-year-old individual is typically caused by aging, trauma, nutritional deficiencies, or underlying health conditions, and treatment should prioritize gentle nail care and addressing underlying causes to improve morbidity, mortality, and quality of life. The causes of horizontal nail splitting can be multifactorial, including aging, trauma, nutritional deficiencies, or underlying health conditions such as thyroid disorders, psoriasis, and peripheral vascular disease 1. Treatment should begin with gentle nail care, including keeping nails trimmed short, avoiding harsh chemicals, and using moisturizers containing urea or lactic acid to hydrate the nail plate.
Some key considerations for treatment include:
- Using biotin supplements (2.5-5 mg daily) to strengthen brittle nails over 3-6 months
- Prescribing nail lacquers containing ingredients like hydroxypropyl chitosan (Nailner) to help bind nail layers together for severe cases
- Ensuring adequate protein, iron, zinc, and vitamin intake through diet or supplements if deficient
- Protecting nails from trauma by wearing gloves during household chores and avoiding picking or biting
- Considering antifungal treatments like ciclopirox nail lacquer or oral terbinafine if fungal infection is present, as indicated by thickening, discoloration, or debris 1.
It is essential to note that improvement typically takes several months as nails grow slowly in older individuals, with complete resolution occurring as the damaged portion grows out. Regular follow-up with a dermatologist is crucial to monitor progress and adjust treatment as needed.
From the Research
Causes of Horizontal Nail Splitting
- Horizontal nail splitting, also known as onychoschizia, can be caused by various factors including aging, nail trauma, exposure to chemicals, and nutritional deficiencies 2, 3
- In the elderly, horizontal nail splitting can be attributed to the natural aging process, which affects the growth rate, color, and texture of the nails 2
- Other potential causes of horizontal nail splitting include fungal infections, such as onychomycosis, and systemic diseases, such as psoriasis and lichen planus 4, 5
Treatment Options for Horizontal Nail Splitting
- Treatment for horizontal nail splitting depends on the underlying cause and may involve topical or systemic medications, such as antifungal agents or corticosteroids 4, 5
- In some cases, discontinuation of offending drugs or avoidance of exposure to harsh chemicals may be necessary to prevent further nail damage 5
- Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important 5
- Nutritional supplements, such as biotin, may be beneficial in treating brittle nail syndrome, which can contribute to horizontal nail splitting 3