Nail Cracking: Causes and Treatment Options

Nail splitting issues?

Hello doctor, I have a severe cracking issue with the nails on both of my thumbs, and the nail beds are uneven.
There is a deep vertical groove in the middle of the nails.
I have tried nail filing, but it is too deep to smooth out.
I have seen doctors regarding this issue, but many are unsure of the cause due to its uniqueness.
Two years ago, the first doctor I consulted suggested it might be due to nutritional deficiencies and proceeded to remove the nail on my right hand.
After it grew back, the nail bed appeared more even, but the surface of the nail began to peel again, forming a new groove that is getting deeper.
I would like to ask: 1.
What possible causes could lead to this issue? I have not received a definitive answer, and without a proper diagnosis, I have not been able to treat it effectively.
One doctor mentioned nutritional deficiencies but was unsure which nutrients were lacking.
Other doctors suggested it might be a fungal infection and prescribed topical ointments, but the results were minimal.
This problem has persisted for over two years, and the new surface also starts to crack.
2.
Does this condition require another nail removal? The right side, which has been removed, looks somewhat better with a more even nail bed, but the nail still cracks.
Should I also consider removing the nail on my left hand, which has a more pronounced uneven nail bed? 3.
The lunula on my thumbs is larger than on my other fingers (up to 1/3), and the nails feel very thin and brittle, making them prone to breaking.
Here is the link to the images: https://lurl.cc/Er8Gk

Yi Hong, 20~29 year old female. Ask Date: 2023/12/07

Dr. Wu Yuxin reply Dermatology

Perhaps related to work, some jobs frequently involve exposure to irritating substances, such as organic solvents and chemicals, which can potentially cause damage to the nails.

Reply Date: 2023/12/07

More Info

Nail cracking and associated issues can be quite distressing, and understanding the underlying causes is crucial for effective treatment. Based on your description, it seems you are experiencing significant nail problems, particularly with your thumbs, characterized by deep grooves, uneven nail beds, and cracking. Let's explore the potential causes and treatment options for your condition.

Possible Causes of Nail Cracking
1. Nutritional Deficiencies: As mentioned by your doctor, nutritional deficiencies can lead to poor nail health. Common deficiencies that affect nails include biotin, zinc, iron, and protein. A lack of these nutrients can result in brittle nails that are prone to cracking and splitting. A comprehensive blood test can help identify any deficiencies.

2. Fungal Infections: Fungal infections can cause changes in nail texture and appearance, leading to cracking and peeling. While you mentioned that topical antifungal treatments had little effect, it may be worth considering a more aggressive treatment approach, including oral antifungal medications, especially if a fungal infection is confirmed.

3. Psoriasis or Other Skin Conditions: Conditions like psoriasis can affect the nails, leading to pitting, ridges, and cracking. If you have a history of skin issues, this could be a contributing factor. A dermatologist can provide a thorough evaluation and recommend appropriate treatments.

4. Trauma or Repeated Injury: Repeated trauma to the nails, whether from manual labor or nail-biting, can lead to structural damage. If you frequently use your hands in a way that subjects your nails to stress, this could be a contributing factor.

5. Genetic Factors: Some individuals may have a genetic predisposition to nail issues. If there is a family history of similar problems, this could be a factor.

Treatment Options
1. Nutritional Support: If nutritional deficiencies are suspected, consider consulting with a nutritionist or your primary care physician to develop a diet rich in essential vitamins and minerals. Supplements may also be beneficial, but should be taken under medical supervision.

2. Topical Treatments: While you have tried antifungal creams with limited success, there are other topical treatments that may help strengthen the nails. Products containing keratin or other strengthening agents can be beneficial.

3. Oral Medications: If a fungal infection is confirmed, oral antifungal medications may be necessary. Additionally, if psoriasis is suspected, systemic treatments may be required.

4. Nail Care: Regularly moisturizing your nails and cuticles can help improve their condition. Avoid harsh chemicals and excessive water exposure, which can exacerbate cracking.

5. Surgical Options: Regarding the possibility of nail removal, this is typically considered a last resort. If the nail bed is severely damaged and causing pain or infection, your doctor may recommend this procedure. However, it’s essential to weigh the benefits and risks, as nail regrowth can be unpredictable.

6. Follow-Up with Specialists: Given the complexity of your case, it may be beneficial to seek a second opinion from a dermatologist who specializes in nail disorders. They can provide a more targeted approach to diagnosis and treatment.

Conclusion
Nail cracking can stem from various causes, including nutritional deficiencies, fungal infections, skin conditions, trauma, and genetic factors. A thorough evaluation by a healthcare professional is essential to determine the underlying cause and develop an appropriate treatment plan. While it may be frustrating to deal with this issue, persistence in seeking the right care can lead to improvement. Keep track of any changes in your nails and communicate openly with your healthcare providers to ensure the best possible outcome.

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