Restasis for Treatment of Brittle Nails

This purpose of this study is to assess the safety and effectiveness of Restasis® ophthalmic emulsion versus emulsion alone( Refresh Dry Eye therapy) both for the treatment of brittle nails and for the enhancement of normal nail growth and texture. The investigators think that daily application of Restasis® to nails and nail beds in patients with brittle nails will enhance nail growth and improve nail texture in both affected and unaffected nails.

This is a single center, investigator-blinded (investigator masked), head to head comparison of Restasis® and its vehicle, Refresh® Dry Eye Therapy in 24 patients. Three target fingernails will be identified in each subject. Two of the target nails will be the two nails that have the most severe signs of brittle nail syndrome. The third target nail will be a normal nail or, in the absence of a normal nail, the patient's second-healthiest appearing nail. The patients most normal-appearing nail will be untreated so that growth in the treated nails can be compared to growth in an untreated normal nail, this will be the fourth target nail. Study medication will be applied to target nails (the subjects may also apply to all nails if they wish, except one nail which will be untreated in order to determine the subject's baseline rate of fingernail growth) for 24 weeks. The target nails will be assessed at each visit, every four weeks. There will be a 12-week follow up period after treatment is completed.

This 36 week study will be conducted at one center. Adult male and female patients meeting the inclusion and exclusion criteria will be screened for eligibility. The principal investigator or his/her designee will obtain informed consent from all patients before any protocol specific procedures are performed.

Eligibility Criteria:
Inclusion Criteria:

* must have IRB approved written informed consent prior to participating in any study related procedures
* Must be a male or female patient 18 to 75 years of age
* must have a diagnosis of brittle or meet the criteria for a diagnosis of brittle nails at the screening visit based on at least two of the following signs and symptoms of brittle nails in each of the selected nail plates or severe signs (one or more) on each target nail
* trachyonychia (surface roughness)
* lamellar onychoschizia (horizontal layering/peeling
* longitudinal cracking or splitting of the distal edge (raggedness)
* must have two fingernails with brittle nail signs and symptoms identified at baseline
* must have two normal or near-normal nails on the same hand
* female patients of childbearing potential (not surgically sterile or at least 2 years postmenopausal) must have a negative pregnancy at baseline/day 1 and may not be lactating
* sexually active female subjects who are not surgically sterile or 2 years post menopausal must agree to use contraception/birth control measure while on study (e.g., oral contraceptive, diaphragms with spermicide, condoms with spermicide, intrauterine devices, Norplant System, Depo-Provera, tubal ligation). Monthly urine pregnancy tests will be administered to women of childbearing potential
* must agree to self administer topical study medication, and must agree to complete all study procedures
* must be judged to be in good health by medical history and physical examination
* must be able to adhere to the study visit schedule and other protocol requirements, including avoiding the use of nail polish, adhesive nails, and manicures for the duration of the study

Exclusion Criteria:

* have a history of surgery of the affected fingernails
* are chronic nail biters
* are pregnant, nursing, or planning pregnancy prior to study enrollment
* have a disturbance of the shape of the affected fingernails (e.g., due to malformation of the underlying bone) that would interfere with the investigator's ability to evaluate photographs or nail changes
* have onycholysis (lifting of the nail plate off the nail bed) of the affected fingernails
* have signs of a fungal or bacterial infection of the affected fingernails
* have a history of psoriasis or lichen planus involving any nail, or active contact dermatitis involving the affected fingernails
* have used any topical cosmetics or medicated products on the affected nails within 2 weeks of baseline visit
* have received oral antifungal treatment within 3 months of baseline visit
* have a known or suspected history of a genetic condition affecting the nails (e.g., Darier's disease, nail-patella syndrome, tuberous sclerosis)
* have used any investigational drug within the previous 1 month or 5 half-lives of the investigational agent, whichever is longer, or 3 months for any biologic of unknown half-life
* are known or suspected to have had a substance abuse (drug or alcohol) problem within the previous 3 years
* is unlikely to comply with the study protocol and prescribed treatment or is unsuitable for any other reason in the opinion of the investigator
* chronic liver, heart, kidney, or (untreated) thyroid disease
* have current signs or symptoms of severe, progressive, or uncontrolled renal, hepatic, hematologic, gastrointestinal, endocrine, pulmonary, cardiac, neurologic, or cerebral disease
* currently have any known malignancy or have a history of malignancy other than non-melanoma skin cancer
* have signs of bacterial, fungal or viral skin lesions that may interfere with evaluation of the target nails
* known sensitivity to any active or inactive ingredient in Restasis(R) or Refresh(R) Dry Eye Therapy