Treatment of Cracked Fingernails
For cracked fingernails (brittle nail syndrome), initiate oral biotin supplementation at 2.5 mg daily for at least 5-6 months, combined with daily application of topical emollients and protective nail care measures. 1, 2
Diagnostic Considerations
Before initiating treatment, distinguish between primary idiopathic brittle nails and secondary causes:
- Primary brittle nail syndrome presents as nails that split, flake, crumble, become soft and lose elasticity, affecting up to 20% of the population (especially women over 50) 1
- Secondary causes to exclude include inflammatory nail disorders, infections (particularly onychomycosis requiring mycological confirmation), systemic diseases, trauma, and hydration alterations 1
- If fungal infection is suspected, obtain microscopy and culture before starting antifungal therapy 3, 4
First-Line Treatment Algorithm
Oral Supplementation
- Biotin 2.5 mg daily is the primary evidence-based treatment, showing definite improvement in 91% of patients after an average of 5.5 months 2
- Continue treatment for a minimum of 5-6 months to see clinical benefit 2, 5
- Alternative: Silicon 10 mg daily (as choline-stabilized orthosilicic acid) may also improve brittle nails 5
Topical Management
- Daily application of emollients to the nail plate, cuticles, and periungual tissues to maintain hydration 3, 1
- Protective nail lacquers to limit water loss from the nail plate 3
- Consider moisturizers and restructuring lacquers to reduce psychological impact 1
Preventive Nail Care Measures
Essential protective strategies to implement immediately:
- Avoid damaging behaviors: no nail biting, cutting nails too short, using fingernails as tools, or applying artificial nails 3, 1
- Limit water exposure: avoid prolonged soaking in water and exposure to solvents or harsh chemicals 3
- Wear cotton gloves during cleaning and household activities 3
- Keep nails trimmed straight across and not too short 3, 4
- Regular application of emollients to maintain nail plate integrity 3
Important Clinical Caveats
Treatment requires patience and compliance: Nail brittleness treatment is challenging and requires strong patient cooperation, as improvement takes months due to slow nail growth rates 6. The nail plate grows slowly, so visible improvement will not be immediate 3.
Limited evidence for other supplements: Despite widespread use, no evidence supports vitamin E, vitamin C, vitamin A, retinoids, zinc, iron, copper, selenium, or vitamin B12 supplementation for improving nail health in well-nourished patients 5. Biotin and silicon are the only supplements with documented efficacy 5.
Environmental factors matter: Progressive dehydration from environmental and occupational exposures plays a significant role in nail brittleness 7. Address these factors concurrently with supplementation for optimal results.
Reassess if no improvement: If there is no improvement after 6 months of biotin supplementation and proper nail care, reconsider the diagnosis and investigate for underlying dermatological or systemic diseases that may be contributing to nail fragility 1, 7.