Q: I’m 62 years old and other medications I’m taking are Estratest. Pravachal, and Synthroid. What can I do to have healthy nails that will grow and not break?

A: You are describing brittle nail syndrome. Oral biotin (see your doctor first) is recommended for brittle nails and has proved successful. Applying acrylic to brittle nails may temporarily improve the condition, but in some clients it leads to other infections. Yeast is the most common fungus seen in lifting nails and brittle nail syndrome, and it is not highly responsive to Grisactin. There are many effective topical treatments. In this particular situation the fungus on the inside of the upper arm and groin area is probably not related to thin, brittle nails. Also the fact that you are taking Synthroid means you have a history of hypothyroidism or and underactive thyroid. People with underactive thyroids, even if taking medication for it, may have a susceptibility to thin, brittle nails. In view of your thyroid disorder and the persistence of brittle nails, a one-time consultation with a dermatologist may be very valuable.

Q: My client has psoriasis of the nails and has been wearing acrylics for three years. All her nails are detached from the nail bed at the free edge. About four months ago she developed pseudomonas spots on about six of her nails. I soaked off the acrylic on these nails and the spots came back. She went to the doctor for a blood test and nothing showed up. What could be the problem? How should I treat it?

A: Clients with nail psoriasis should not wear acrylics because the acrylic can sometimes aggravate the condition. This can be due to an allergic reaction or a phenomenon called Koebner Phenomenon, in which a minor injury to the nail worsens the psoriasis and can cause increased lifting from the nail bed’s free edge. Psoriasis nails are more susceptible to both yeast and pseudomonas infections. Therefore, clients with nail psoriasis should see a dermatologist who will take samples of the nail to determine if there is a yeast or bacterial infection present and prescribe the proper treatment. A blood test will not detect a nail infection.

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Q: I have an 86-year-old client whose nails are white and dry and peel beginning at the free edge, working its way up toward the cuticle. She receives a manicure every other week and does not use a nail strengthener at home. Also, her polish won’t stay on for more than a few days. The skin around her nails looks healthy. I’ve asked her to see a doctor, but she says she’s too old to worry about it. Could the condition be caused by a yeast infection or overuse of a nail strengthener?

A: Whiteness, dryness, and peeling of the nails are usually signs of brittle nail syndrome, which is caused by dehydration or loss of moisture in the nail plate, which is very common in order clients. If the nails are also white, it may be due to the fact that they are lifting or are not attaching to the nail bed, a condition known as onycholysis. If this is the case, the client may have a yeast infection because many cases of onycholysis are caused by yeast. The diagnosis can only be made by a dermatologist who will take samples of the nail to see if there is in fact a yeast fungus present. As for nail strengtheners, products containing formaldehyde can cause the nail plate to separate from the nail bed, so I would strongly encourage clients with this nail condition to use a formaldehyde-free nail strengthener. Regular manicures are OK, but avoid over-manipulation of the cuticles as well as over-vigorous cleaning underneath the nail plate because this can lead to lifting. Problems with polish adhesion are very common in clients with brittle nail syndrome. The only suggestion is to keep the nails well moisturized and apply two coats of base coat prior to polish application.

Q: I have natural nails that grow to a nice length then suddenly break off. My nails are not thin and they do not peel or fray. Every now and then I will get nail tips put on for about two months, then take them off. My nails tend to become weak right after having the tips removed, but they usually return to their healthy state after a month. I’ve had the tips off for three months now and my nails are growing nicely, but they constantly break. What could be causing this?

A: Nails that constantly break are usually a result of moisture loss in the nail plate or dehydration, which makes nails more susceptible to breakage. The best way to treat this condition is to soak the nails in warm water for 15 minutes at bedtime and then apply a good moisturizer on the nails, especially around the cuticle area because it’s near the nail growth center. Having tips put on is perfectly OK.

Q: I have a client who has a split in her thumbnail that starts at the cuticle and runs halfway down the nail. It is deep, but not bleeding. She says she didn’t hit it or slam it in a door. What would cause this condition, and what can we do to help it heal?

A: A split in the nail could be due to a space-occupying lesion (a tumor or growth) or scar and should be evaluated by a dermatologist. Depending on the appearance of the split and the size of it, it may require a biopsy to determine what the cause is. This is especially true if there is no history of an injury, as you mentioned. Therefore, in order for it to heal, a definite diagnosis must be made.