Brittle Nails 15 Onychorrhexis What Not To Miss Underlying etiologies such as hypothyroid, anorexia, bulimia, oral retinoids, or anemia Key DDx Early lichen planus 20 nail dystrophy Work Up Pearls Can be idiopathic or due to nail plate trauma Risk Factors wet working conditions, trauma, excessive manicures Treatment Ladder Reduce exposure of nails to chemicals wear rubber gloves Apply petrolatum, lanolin, glycerin, or propylene glycol to moisturize Can use daily nail strengthening lacquer with 16 polyureathane Biotin 5 10 mg daily for at least 6 months but should see improvement at 2 months PEARL Biotin can affect thyroid testing and also cardiac markers so be cautious 16 Replenish iron if ferritin 6 weeks Common causes idiopathic, autoimmune, drug induced, infection related Can also include physical urticarias such as cold, delayed pressure, solar, heat, vibratory and cholinergic Chronic urticaria associated with autoimmune thyroid disease and other autoimmune conditions Certain medications can make urticaria worse Notably aspirin and NSAIDs Urticarial vasculitis Painful or burning lesions lasting 24 h Leaves post inflammatory hyperpigmentation Key DDx <a href=https://cialiss.cfd>cialis prices</a> 2 Soft bodied ticks more typically inhabit mammalian burrows and nests, emerging at regular intervals to feed on their hosts for short periods of time