What is the treatment for vertical lines on fingernails?

Treatment for Vertical Lines on Fingernails

The treatment for vertical lines on fingernails depends on the underlying cause, but for idiopathic brittle nail syndrome, oral biotin supplementation combined with topical moisturizers is the most effective approach. 1

Diagnosis and Causes

Before initiating treatment, it's important to identify the cause of vertical lines on fingernails:

• Vertical lines (onychorrhexis) are often a sign of nail brittleness, affecting up to 20% of the population, especially women over 50 years of age 1
• These can be primary (idiopathic brittle nail syndrome) or secondary to various conditions 1
• Secondary causes include:
  • Inflammatory nail disorders
  • Fungal infections (onychomycosis)
  • Systemic diseases
  • Trauma
  • Dehydration of the nail plate 1, 2

Treatment Algorithm

Step 1: Address Underlying Conditions

• If fungal infection is present, treat with appropriate antifungals:
  • For fingernail infections: Terbinafine 250 mg daily for 6 weeks (first-line) or itraconazole 200 mg daily for 12 weeks 3
  • For superficial infections: Consider topical options like amorolfine 5% lacquer applied once or twice weekly 3

Step 2: For Idiopathic Brittle Nails with Vertical Lines

• First-line treatment:

  • Oral biotin (vitamin B7) supplementation 4, 1
  • Amino acid supplements, particularly cysteine 1
  • Trace element supplementation 1

• Topical treatments:

  • Moisturizing nail lacquers to prevent dehydration 4, 1
  • Nail hardeners for temporary improvement 1

Step 3: Preventive Measures

• Avoid prolonged water exposure 4
• Use cotton gloves for wet work 4
• Avoid nail trauma and harsh chemicals 4, 1
• Apply emollients regularly to nail folds and plates 3

Special Considerations

• If vertical lines are associated with psoriasis:

  • For <3 nails: Intralesional triamcinolone acetonide (5-10 mg/cc) 3
  • For nail bed involvement: Topical steroids with or without vitamin D analogs 3

• If associated with paronychia (inflammation around nails):

  • Daily dilute vinegar soaks (50:50 dilution) to nail folds twice daily 3
  • Mid to high potency topical steroid ointment to nail folds twice daily 3

Monitoring and Follow-up

• Improvement in nail brittleness may take 3-6 months due to slow nail growth 1
• If no improvement after 6 months, reassess for underlying conditions 2
• If vertical lines are associated with systemic disease (e.g., renal disease presenting as half-and-half nails), treatment of the underlying condition may improve nail appearance 5

Pitfalls and Caveats

• Vertical lines may be normal aging changes and not always pathological 2
• Don't mistake Muehrcke lines (horizontal white bands) for vertical lines - these can indicate systemic disease like rheumatoid arthritis 6
• Avoid aggressive mechanical nail treatments which can worsen nail brittleness 4
• Biotin supplementation may interfere with certain laboratory tests, including thyroid function tests and troponin levels 1