Topical Cyclosporine Suspension for the Treatment of Brittle Nails
Brittle nail syndrome (BNS) refers to nails that exhibit splitting, raggedness (fraying of the distal edge), and peeling (lamellar onychoschizia).(1) This is a common problem, affecting approximately 20% of women, with higher prevalence among the elderly.(2) A number of factors have been proposed as possible causes of nail brittleness, such as anemia, biotin deficiency, or cysteine deficiency. (3,4) However, most authors believe that brittle nails are usually caused by dehydration of the nail plate, either from repetitive cycles of hydration and dehydration related to hand washing or from exposure to dehydrating chemicals, such as those found in nail enamel and cuticle removers. (5,6) Inflammation of the nail as a potential contributing factor has never been studied.
There are currently not consistently effective treatments for this condition. Restasis® is effective in treating keratoconjunctivitis sicca. This condition is characterized by the troublesome condition of dry eyes partially due to decreased tear production exacerbated by inflammation. The BNS manifests itself by nail plate dehydration. The two conditions have in common disruption of water balance which gives rise to problematic clinical disorders. The hypothesis is that a product which benefits tear production would also be effective for brittle nails which contain roughly 15% water.
Brittle Nail Syndrome
Drug: topical cyclosporine ophthalmic suspension 0.05%
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Treatment
|Official Title:||A Single Center, Investigator-blinded Study of the Efficacy of Topical Cyclosporine 0.05% Ophthalmic Suspension (RESTASIS®) Under Occlusion Versus Vehicle in the Treatment of Brittle Nail Syndrome|
- • Number of Patients Receiving at Least a 1-grade Improvement in the Physicians Global Improvement Assessment (PGIA) of Two Target Nails. [ Time Frame: 20 weeks ] [ Designated as safety issue: No ]IN a scale of 0-3 where 0 means normal nail and 3 means severe disease, the number of patients who received at least a decrease of 1 grade in the evaluation of two target nails
- Patients Assessment of Satisfaction With Length of Fingernails [ Time Frame: 20 weeks ] [ Designated as safety issue: No ]the percentages of participants who were satisfied with the "length of fingernails"
|Study Start Date:||February 2010|
|Study Completion Date:||August 2011|
|Primary Completion Date:||August 2011 (Final data collection date for primary outcome measure)|
Active Comparator: topical cyclosporine suspension
apply 2 drops to 2 target nails under occlusion daily for 20 weeks
Drug: topical cyclosporine ophthalmic suspension 0.05%
apply 2 drops to 2 target fingernails under occlusion daily
Other Name: Restasis
Placebo Comparator: vehicle
apply to target nails daily under occlusion daily for 20 weeks
apply 2 drops to 2 target fingernails under occlusion daily for 20 weeks
Other Name: Refresh Dry Eye Therapy
Brittle nail syndrome (BNS) is a heterogeneous abnormality, characterized by increased fragility of the nail plate. About 20% of the population is affected by brittle nails and women are affected twice as frequently as men. (2). The diagnostic criteria for brittle nails are not well defined but most authors agree in at least these 3 criteria: onychoschizia (lamellar splitting of the free edge and distal portion of the nail plate), onychorrhexis (longitudinal thickening and thinning or ridging of the nail plate) and fraying or raggedness of the distal edge causing transverse splitting.
Although the cause of nail brittleness is unknown, most authors believe that it is caused by dehydration of the nail plate and that frequent cycles of hydration and dehydration as well as various mechanical and chemical insults increase the incidence of brittle nails. (7) The nail plate contains about 15% water and a very low lipid content so water permeation through the nail plate is high.(8) In fact, it has been demonstrated that the flux of water across the nail plate is 10 times more than the epidermis and 1000 times more permeable than the stratum corneum.(9) A recent report show that there was no significant difference in water content of brittle nails when compared to normal nails and suggested that nail plate water content is random and that nail plates are in a constant state of influx and efflux of water. (10) Keratoconjunctivitis sicca is a chronic, bilateral desiccation of the conjunctiva and cornea due to an inadequate tear film. There are two types: one caused by an inadequate tear volume and the other one caused by an accelerated tear evaporation due to poor tear quality (11). Restasis® (cyclosporine 0.05% topical emulsion) is effective in treating keratoconjunctivitis sicca.
BNS and keratoconjunctivitis sicca have in common a disruption of water balance which gives rise to problematic clinical disorders. We hypothesize that a product which improves corneal dehydration would also be effective for brittle nails. Our rationale for using occlusion is that is has been shown that occluding the skin with a vapor-permeable membrane increases the water flux and the barrier function is recovered at a normal rate. (12) We also hypothesize that using Restasis® (cyclosporine 0.05% topical emulsion) or its vehicle (Refresh Dry Eye Therapy®) under occlusion with a finger cot will increase the nail plate hydration balance and as a consequence will improve nail brittleness. Topical cyclosporine has been shown to be safe in the treatment of other dermatological conditions such as nail psoriasis and oral lichen planus. (13,14) An investigator-blinded design will differentiate if the observed effects are caused by the active ingredient in Restasis® (cyclosporine 0.05% topical emulsion) or its vehicle (Refresh Dry Eye Therapy®).
Please refer to this study by its ClinicalTrials.gov identifier: NCT01064830
|United States, North Carolina|
|University of North Carolina|
|Chapel Hill, North Carolina, United States, 27516|
|Principal Investigator:||Aida Lugo-Somolinos, MD||UNC- Chapel Hill|