Cracking up: Waterless hand sanitizers, fragrances weaken nails

October 1, 2009

The surge in waterless hand sanitizers is creating an increase in brittle nails. An expert discusses some tried-and-true treatments that can help.

Key Points

"A lot of people are using waterless hand sanitizers instead of washing their hands, and some people use them all the time," says Zoe Draelos, M.D., investigator, Dermatology Consulting Services, and clinical dermatologist in High Point, N.C.

"Society is become increasingly germ-phobic, and these waterless hand sanitizers dry out the nails. ... They are the biggest cause of increased brittle nails," she says.

"When you flick the edge of the nail and it doesn't crack, that's the water in the nail. The water allows it to deform in a plastic fashion as opposed to a brittle fashion," she says.

Other culprits

Other culprits are the highly fragranced lotions from popular body lotion stores and aromatherapy spas.

"Some people love the way these products smell, and they apply them all day, every hour or more," Dr. Draelos says.

The repeated wetting and drying of the nails can result in nail plate dehydration and brittleness.

Seeking treatment

While brittle nails are usually not reason enough to visit a dermatologist, most patients bring the condition up after their primary concern has been addressed in the office. "It's a 'hand-on-the-doorknob' problem," Dr. Draelos says. "The patient will say, 'Oh, by the way ...'"

Brittle nails are easy to spot, however.

"Physicians will notice that the nails are broken, with fissures at the tips. Although nails are largely of cosmetic importance, if the nail breaks, it can become quite painful, and sometimes the nail plate can fracture and tear into the nail bed," Dr. Draelos adds. "This can provide a site for infection by a multitude of organisms, including bacteria and fungal organisms."

While brittle nails are common on the hands, toenails are less likely to be affected, because they are thicker and not as exposed to solvents, trauma and products that dehydrate.

Brittle nails become more of a problem as people age, since the nails are not as strong as they once were. Typically, the problem is more common in women than in men, because women wear their nails longer. The longer nail keratin has been around, the more likely it is to become damaged and dehydrated.

Rehydrating nails

To combat the problem, some old ingredients are being rediscovered. Two elements that work well are urea and lactic acid.

"Both substances degrade protein, and protein is the main substance in nails," Dr. Draelos says. "If you degrade protein, sites open up for water to bind to the nail keratin, and that temporarily rehydrates the nail plate."

But too much urea can actually digest so much of the nail that it weakens and becomes soft, she says.

Dr. Draelos recommends moisturizing the nails at bedtime with urea or lactic acid cream. In some cases, biotin supplements orally can also be helpful for brittle nails.

Despite the fact that brittle nails are most often an aesthetic issue, they can be a problem that patients will discuss with their dermatologist. Dr. Draelos offers these talking points:

"I think dermatologists need to have something to tell their patients when they ask, so the patients feel that they are receiving appropriate medical care and that their doctor has attended to all of their needs," Dr. Draelos says. "It's a common problem that can be helped."