Boni Elewski, MD offered some excellent tips during a practical session on nail care and treatment of nail pathology. She began with a comprehensive review of the nail unit, during which she highlighted the important but often overlooked fact that nails are 1000 times more permeable to water than epidermis, leaving the nail unit highly susceptible to changes in hydration status.
She segued into a discussion on brittle nails, commonly thought to be related to nail dehydration. She debunked this myth by presenting data from a 2007 study published in JAAD which revealed almost identical water content in normal nails and brittle nails.
Dr. Elewski then highlighted the positive association between manicure frequency and incidence of brittle nails—raising the age-old “chicken or the egg” question: do manicures lead to brittle nails or do people with brittle nails get more manicures in an attempt to hide the condition?
Dr. Elewski then discussed nail conditioners available for treatment of brittle nails, including 82% isopropyl alcohol and a mixture of lanolin, petrolatum, and beeswax. She gave an update on the use of biotin supplementation for treatment of brittle nails. This is an area that has caused significant controversy as of late, due to the interference of the supplement with laboratory tests such as thyroid function panels and cardiac enzyme assays. Dr. Elewski reviewed these caveats and urged cautious use of biotin in patients with brittle nails.