Sophia Delgado
Many medications have been linked to nail abnormalities, including nail thinning, fragility, and brittleness. These changes are often due to damage to the nail matrix and nail plate. While nail abnormalities are more common with cancer medications, they have also been observed with other drugs such as retinoids, tetracyclines, and oral contraceptives. In some cases, discontinuing the medication may resolve the nail issues, but it is important to consult a healthcare professional before stopping any prescribed treatment. Topical steroids are sometimes used to treat nail infections and abnormalities, but their effectiveness in improving nail health is unclear. Additionally, brittle nails can be a sign of iron deficiency, which may be a concern for individuals taking certain medications that affect iron levels.
| Characteristics | Values |
|---|---|
| Drugs that cause nail brittleness | Retinoids, tetracyclines, chemotherapy agents, MEK inhibitors, mTOR inhibitors, BCL-ABL inhibitors, VEGFR inhibitors, oral contraceptives, fluconazole, itraconazole, levodopa, antiretroviral drugs, ciclosporin, heparin, lithium, methotrexate, and antibiotics |
| Drug-induced nail disease symptoms | Nail thinning, fragility, brittleness, pigmentation changes, nail growth changes, Beau lines, onychomadesis, leukonychia, onychoschizia, onychorrhexis, onycholysis, periungual inflammation, nail cracking, and nail dystrophy |
| Drug-induced nail disease treatment | Discontinuing the causative medication, applying nail enamel, topical steroids, antibiotics, and cautery, oral biotin (unproven), and protecting the nail bed from ultraviolet exposure |
| Nail brittleness causes | Iron deficiency, low ferritin levels |
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What You'll Learn
Steroids can cause brittle nails due to iron deficiency
Steroid use has been linked to nail abnormalities, including nail thinning, fragility, and brittleness. These signs are often caused by long-term use and higher dosages of certain drugs. While steroids can directly cause nail brittleness, they can also cause it indirectly by potentially causing iron deficiency.
Iron deficiency, also known as anaemia, is a common condition worldwide. It occurs when an individual does not have enough iron in their body, which is necessary for producing new red blood cells. Iron deficiency can cause various symptoms, including constant fatigue, chills, shortness of breath, pale skin, and a constant feeling of cold.
One of the less common but significant indicators of iron deficiency is brittle nails. This condition, known as koilonychia or spoon nails, is characterised by thin, brittle, and concave nails that can take on a spoon-like appearance. Spoon nails can be associated with chronic iron deficiency, which may result from malnutrition, chronic blood loss, or malabsorption issues.
The exact mechanism by which iron deficiency leads to spoon nails is not fully understood. However, researchers believe it may be related to reduced iron levels in iron-containing enzymes found in epithelial cells, which cover the skin surfaces inside and outside the body.
If you suspect that your steroid use is causing nail brittleness due to iron deficiency, it is essential to consult a healthcare professional. They can perform the necessary evaluations, including blood tests, to determine the underlying cause and recommend appropriate treatments or lifestyle changes to address the issue.
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Medication can cause nail thinning, fragility and brittleness
Medication can indeed cause nail thinning, fragility and brittleness. This is due to diffuse damage to the nail matrix and nail plate. The higher the dose of the drug, the more likely it is to cause nail disease.
Drug-induced nail changes are side effects that can develop after starting a new medication. Some medications cause minor symptoms, such as cosmetic changes to nail colour, while others can be more serious and involve infection and nails separating from the nail bed. Nail psoriasis, for example, is an autoimmune condition that causes discoloration, pitting, and changes in fingernails and toenails.
The most common drugs that affect nail health include cancer medications, such as chemotherapy agents and retinoids, as well as tetracyclines, antibiotics, anti-seizure medications, blood thinners, and lithium. These medications can also cause nails to grow more quickly or slowly.
Most nail abnormalities improve when the causative drug is discontinued, but it may take months or even years for the nails to return to their normal appearance due to their slow growth. It is important to note that you should never stop taking your medication without consulting your healthcare professional first.
If you are experiencing nail thinning, fragility, or brittleness, there are some treatments you can consider. Applying emollients and a poly-ureaurethane product can help protect and strengthen your nails. Keeping your nails trimmed short and using cotton gloves under latex gloves for wet work can also help. Topical steroids and antibiotics may be recommended by your healthcare provider if you are experiencing a skin infection around your nails.
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Drug-induced nail disease is more common in older people
Drug-induced nail disease is indeed more common in older people, particularly those exposed to multiple medications. This is due in part to older people generally being on more medications than younger people, increasing the likelihood of drug-induced nail disease.
The signs and symptoms of drug-induced nail disease depend on the specific drug being taken and the dosage. They are often noticed some weeks or months after the drug has been started and may affect a single nail, multiple fingernails, or toenails. Symptoms can include limitations in handling small objects, changes in nail growth rate, and pigmentation of the nail plate. Drug-induced nail disease can also cause damage to the nail matrix (the hidden part of the nail unit under the cuticle), the nail bed (the skin beneath the nail plate), periungual tissue (tissue around the nail), and blood vessels feeding the nail or nails.
In addition to medication, nail changes in older people can be caused by trauma, advancing age, faulty biomechanics, and underlying systemic diseases. For example, splinter hemorrhages under the nail plate are commonly associated with trauma in older adults and usually resolve spontaneously. On the other hand, proximal splinter hemorrhages are typically linked to systemic diseases such as cholesterol emboli, connective tissue disorders, or infective endocarditis.
The incidence of nail apparatus malignancies, such as Bowen disease and melanoma, also tends to increase with age and is usually highest in the elderly population. Bowen disease of the nail unit can manifest as a periungual or subungual ulcerated hyperkeratotic lesion associated with onycholysis or longitudinal melanonychia. Treatment for Bowen disease typically involves Mohs micrographic surgery.
It is important to consult a healthcare professional if you experience any concerning nail changes, as they can recommend ways to manage side effects and determine if discontinuing the causative medication is appropriate.
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Topical steroids can help treat nail infections
While steroids can cause nail abnormalities, they can also be used to treat nail infections. Topical steroids are often used to treat skin infections around the nails. For example, in a study of 48 nails treated with methylprednisolone aceponate, a topical steroid, 41 were improved or cured at the end of the follow-up period.
Topical steroids are also used to treat onycholysis, a nail disorder characterized by the separation of the nail plate from the nail bed. This disorder can be caused by drug use, chemotherapy, or ultraviolet radiation. Mid-strength topical steroids are suitable for isolated onycholysis, while high-potency topical steroids can be used for severe cases.
It is important to note that steroids should not be used to treat ringworm or fungal nail infections, as they can make these infections worse. Instead, antifungal medications are used to treat these types of infections.
If you are experiencing nail abnormalities, it is important to consult with a healthcare professional to determine the underlying cause and appropriate treatment.
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Chemotherapy can cause nail changes, including pain
While nail problems are not a common occurrence with most medications, they are mostly linked to a few specific drugs, including chemotherapy agents. Chemotherapy can cause nail changes, most of which are only a cosmetic concern and disappear once patients stop taking the medication. However, some nail changes can be painful and disabling, substantially impacting a person's quality of life.
Chemotherapy patients often experience pigmentation in their nail plates that does not go away. Although this is not symptomatic, many patients worry that they have nail melanoma or skin cancer under their nails. Patients may also develop Beau's lines, which are depressed linear bands on the nail plate caused by an arrest in the mitotic activity of the nail matrix. Repeated chemotherapy cycles can lead to multiple Beau's lines on multiple nails.
Another nail change that can be caused by chemotherapy is onychoschizia, or horizontal or lamellar splitting of the nail plate. This is due to diffuse damage to the nail matrix and nail plate. Onycholysis, or the separation of the nail plate from the nail bed, can also occur due to toxin damage to the nail bed. This can cause nails to appear white, yellow, or brown due to subungual hemorrhage. Onycholysis is often painful and can be caused by exposure to ultraviolet radiation, although this generally does not affect thumbnails.
Some chemotherapy patients may also experience nail thickening, which can be long-term. In some cases, a random nail may grow back thick and painful. In these instances, doctors may remove the nail and see if it grows back normally. If it doesn't, they may kill the whole matrix so that the nail doesn't grow back at all.
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Frequently asked questions
Brittle nails can be caused by a variety of factors, including iron deficiency, long-term use of chemotherapy agents, retinoids, tetracyclines, and certain medications.
Yes, steroids can cause brittle nails, particularly when used in high doses or in combination with other medications. However, this is not a common side effect and is typically associated with specific types of steroids, such as MEK inhibitors and mTOR inhibitors.
The signs and symptoms of steroid-induced brittle nails may include nail thinning, fragility, changes in nail colour, and nail separation from the nail bed. These symptoms can affect a single nail or all the fingernails and sometimes the toenails.
If you experience brittle nails while taking steroids, it is important to consult a healthcare professional. They may recommend discontinuing or adjusting the medication, applying topical treatments such as emollients or poly-ureaurethane, and protecting your nails by keeping them trimmed and covered during wet work.
Yes, nail brittleness can also be caused by nail psoriasis, an autoimmune condition that affects nail colour, structure, and thickness. Additionally, chemotherapy agents and certain cancer medications are commonly associated with nail changes, including brittleness.
