Aprile Vol.2 N° 1 - 2006 - Salute per tutti

32
A. Sparavigna, M. Setaro, M. Genet, L. Frisenda
tent is reduced, the nail becomes brittle.
Splitting, which results from this brittle quality,
is probably due to repeated uptake and drying
out of water.
Moreover, the keratin content may be modified
by physical insults and/or chemicals such as
acrylic products used for printing colours, nail
lacquers, organic solvents, formaldehyde, and
hydroxylamine, these two latter widely used in
chemical and pharmaceutical industry.
Nail fragility may be due either to nail plate
impairment or to matrix impairment: the nail
may be damaged by trauma or by chemical
agents such as detergents, alkaline solvents and
especially by hot water. Prolonged immersion in
water with alkalis or with powerful detergents
render the nails softer and easily damageable.
Climatic and seasonal factors may also affect the
hydration of the nail plate.
Fragility, due to thinning of the nail plate, may
be caused by a reduction in the length of the
matrix. Diminution or even complete arrest of
nail formation over a variable width, may be the
result of many dermatoses such as eczema,
lichen planus and impairment of the peripheral
circulation. Additional causative factors for nail
fragility are repeated microtrauma, infection,
reduction in serum iron, vitamin A, B6, C deficiency,
osteoporosis and numerous inherited
defects associated with the atrophy of the nail.
Dermatological or systemic diseases may also
contribute to these alterations (2).
Nail plate abnormalities include onychoschizia,
that is horizontal lamellar splitting of the free
edge of the nail into fine layers, affecting 27 to
35% of normal adult women (1). This condition,
caused by exogenous factors, is commonly seen
in housekeepers as their nails are repeatedly
soaked in water and then dried.
Onycholysis refers to the detachment of the nail
from its bed at its distal end and/or its lateral
attachments. It may be associated with trauma,
but most frequently onycholysis is due to chemical
irritants or sensitizers substances, cold and
hot injury and it is related to nail fragility (1).
Onycholyses of the toenail is mainly associated
with onychomycosis and repeated microtraumas.
Other abnormalities include longitudinal
grooves that may occur physiologically as shallow
and delicate furrows but may become more
prominent with age and in certain pathological
conditions (lichen planus, rheumatoid arthritis)
and longitudinal ridges that are small rectilinear
Journal of Plastic Dermatology 2006; 2, 1
projections that extend from the proximal nail
fold until the free edge of the nail, or may stop
short. Transverse lines, the so called “Beau
Lines”, characterized by superficial grooves,
most frequently affecting the thumbs and big
toes, are indicators of previous disease (1).
These lines reflect a temporary reduction in
matrix activity (1).
Nail changes most frequently occur in elderly
people due to the slow nail growth at that age
(reduction in tissue repair), setting up of degenerative
process and/or alterations of peripheral
circulation.
Nail alterations cannot be neglected as they represent
a suitable media for setting up fungal or
bacteria infections which result in discomfort
and pain. Moreover, unhealthy looking nails
may cause a certain embarrassment, especially
for certain professionals affecting subject’s selfesteem.
There is no efficient cream able to prevent oversoftening
of the nails due to water or detergents.
After hydration, the nail plate should be massaged
with mineral oil or a lubricating cream to
prevent the nail to drying out. Products containing
5% aluminium chloride in propylene glycol
claim to make the nails harden, on the contrary
such products make the nails stiff, brittle and less
flexible. Nail varnish (water-insoluble polyvinyl
resin film) acts in a similar way but the use of
organic solvent for its removal damages nail
structure by increasing nail splitting and fragility.
Systemic treatment may be helpful. Oral iron (for
6 months) even in absence of demonstrable iron
deficiency, may be useful. More recently, biotin
supplementation has been suggested for the
treatment of brittle nails (3). Some nail alterations
have been described as secondary to other
therapy: docetaxel (4) or gold therapy (5).
Treatment for onycholysis consists of a silicone
rubber moulded toe cap or a silicone rubber
orthodigital splint or a direct moulding splint,
the device being produced in situ (1).
A new, original topical formulation has been proposed
to overcome and solve most of the above
mentioned nail abnormalities. It is based on
Equisetum arvense (a plant extract) and methylsulfonyl
methane (a sulfur donor) in a hydroalcoholic
solution into a new technology based on
chitosan derivatives as film-forming agents for
delivery of actives to nails.
Its three main ingredients interact for the regeneration
of a healthy and strong nail structure:
Equisetum arvense provides organic silica, it