Q&A: improving nail strength; caring for dry, aging skin; preventing ovarian cancer; & long-term antihistamine use
Join me today 2/14 at 3 pm ET for a live Q&A - right here!
ICYMI 👉
📣 Join me TODAY, February 14, at 3 pm ET for our WEEKLY live chat in the Substack App!
This is a free event! Paid subscribers can submit questions by commenting below or via the paid subscriber group chat here! 📣
In this week’s reader-submitted Q&A, we’re tackling these questions:
How can I strengthen my nails?
How can I protect my dry, aging skin?
What can I do to prevent ovarian cancer?
What are the health effects of long-term Zyrtec use?
📣 Send me your questions for future Q&As! Click here to write me. ✍️
The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: IMPROVING NAIL STRENGTH
I've noticed that I have some vertical splitting in some nails that have developed over the past several years. I'm almost 55 yrs old and not sure if the nail weakness is related to hormonal changes since my prophylactic hysterectomy/oopherectomy 12 yrs ago (taking minimal dose of HRT - estrogen) or whether it's related to the effects of nail polish over many years/not giving my nails a chance to breathe. Should I be taking any vitamins/supplements to strengthen my nails? Should I swear off nail polish? That would be sad because looking at my nicely colored nails is one of the small pleasures in life!
-Jen
Hi Jen,
I’m with you! I love a cheerful nail polish, especially on gloomy winter days. The vertical splitting you are describing is called “onychorrhexis” and can occur as a result of any combination of age, hormonal changes, nutritional deficiencies, dehydration, certain medical conditions, and external wear-and-tear.
Regarding hormones: it’s important to know that estrogen plays a role in collagen production and moisture retention, both of which help maintain nail strength. As estrogen declines, nails can become drier and more brittle. It’s possible that the abrupt change in your hormone levels after your ovaries were surgically removed played a role in your nail issues. So, being on low-dose estrogen is probably helping your nails overall. It’s also possible that a higher dose would help you even more. Of course speak to your doctor about all.
Long-term use of nail polish isn’t inherently damaging, but frequent exposure to harsh removers (especially acetone-based ones) and gel manicures can weaken the nail plate over time. That said, you don’t have to give up painting your nails if it brings you joy! I would just focus on strengthening your nails from the inside out.
A few things that may help:
Biotin (Vitamin B7): Some studies suggest that 2.5 mg daily can improve nail strength over time.
Collagen peptides: Collagen supplementation has been shown to support nail health and reduce brittleness.
Iron and zinc: Deficiencies in these can contribute to weak, peeling nails, so it's worth checking levels if you suspect a deficiency.
Hydration and cuticle care: Keeping nails moisturized with a nourishing oil (like jojoba or vitamin E) can help prevent splitting.
Nail polish strategy: Stick to non-toxic, strengthening polishes, and try using a hydrating base coat. Give your nails occasional breaks if possible, but no need to swear off polish entirely.
It might be worth discussing with a dermatologist or your primary care doc. But in general, a combination of gentle care, hydration, and targeted nutrition can go a long way in keeping your nails strong while still enjoying your favorite polish colors! 💅
QUESTION #2: CARING FOR DRY, AGING SKIN
I am a 67 year old female and would like to know how to care for my hands - the skin has become so stiff and painful when I rub them. They are easily wounded as well. Sometimes I don't even know how I cut myself; I just start bleeding! I currently use Cerave, which has helped, but it is not enough. Any suggestions?
-Trish
Hi Trish,
You are not alone! Aging skin, especially on the hands, can become thinner, drier, and more fragile due to a natural decline in collagen, elastin, and moisture retention. The fact that your hands feel stiff, painful, and prone to easy injury suggests that the skin barrier may be compromised, making it more susceptible to irritation and damage. While CeraVe is a great choice for hydration, adding a few additional strategies may help strengthen and protect your hands.
First, boost hydration and barrier repair by layering an occlusive moisturizer over your regular lotion. Products with ingredients like petrolatum (Vaseline), lanolin, or dimethicone create a protective seal to lock in moisture. Try applying a thick layer before bed and wearing cotton gloves overnight to enhance absorption. (The obvious problem is getting overheated during the night!)
Next, be sure to use only gentle, fragrance-free soaps—and try to wear gloves when doing housework or handling anything that could cause micro-tears. Exposure to hot water, detergents, and frequent handwashing can strip the skin of its natural oils, so try using lukewarm water and a hydrating hand wash.
To support skin healing and resilience, look for moisturizers with urea, hyaluronic acid, or glycerin to deeply hydrate, and niacinamide to improve skin barrier function. Since easy bruising and skin thinning can sometimes indicate nutrient deficiencies, it may be worth ensuring adequate vitamin C, vitamin D, collagen, and essential fatty acids in your diet. Omega-3 supplements or flaxseed oil may help improve skin elasticity over time.
It also might be helpful to check with a dermatologist or your primary care doctor to rule out underlying conditions like circulatory issues, diabetes, or autoimmune disorders that can contribute to fragile skin. But it’s important to know that small daily changes can make a big difference in protecting your hands. I hope that helps!
QUESTION #3: PREVENTING OVARIAN CANCER
I worry about ovarian cancer because I know someone who died from it and because it’s called a silent killer. Every twinge near my ovaries has me worried. I have had an ovarian cyst which did cause lower abdominal pain. I was so worried I convince my doctor to order and vaginal ultrasound and fortunately there was nothing there. What can one do to protect themselves from cancers like this that don’t have symptoms or have symptoms that are often mistaken for something else? My understanding is that this is often found in late stages because of this.
-Jill
Hi Jill,
Your concerns about ovarian cancer are completely understandable, especially given its reputation as a "silent killer." Ovarian cancer is often diagnosed in later stages because its early symptoms—bloating, pelvic discomfort, changes in bowel habits, and feeling full quickly—can be vague and mistaken for less serious conditions. However, there are proactive steps you can take to protect yourself and stay vigilant.
First, know your risk factors. While most cases of ovarian cancer are sporadic, some people are at higher risk due to family history, genetic mutations (like BRCA1 and BRCA2), or certain reproductive factors. If you have a strong family history of ovarian, breast, or other related cancers, you may want to discuss genetic testing with your doctor. Patients at higher risk based on genetics or other factors should have more frequent surveillance testing and/or consider prophylactic surgery to remove the ovaries and fallopian tubes.
Second, pay attention to persistent symptoms. The occasional twinge or discomfort is usually not a cause for concern, but if symptoms like bloating, pelvic pain, or changes in digestion persist for more than a couple of weeks, you should bring them up with your doctor. You did the right thing by advocating for a transvaginal ultrasound when you were concerned.
Routine screening for ovarian cancer is not recommended for the general population because current tests (like transvaginal ultrasound and the “CA-125” blood test) are not always reliable for detecting early-stage cancer. However, if you are high-risk, your doctor may suggest periodic monitoring.
Lifestyle factors may also play a role in lowering risk. Some research suggests that maintaining a healthy weight, eating a nutrient-rich diet, and reducing inflammation in the body may help reduce overall cancer risk. The use of oral contraceptives has been shown to significantly lower ovarian cancer risk, so if you have a history of taking birth control pills, you may already have some added protection.
The upshot: We need more reliable screening tests and a clearer understanding of who is at highest risk for ovarian cancer. For now, the most important thing is to stay informed, listen to your body, maintain regular check-ups with your doctor, and be sure to raise your hand when something doesn’t feel right. 🙋🏻♀️
QUESTION #4: EFFECTS OF LONG-TERM ANTIHISTAMINE USE
My doctor has recommended that I take Zyrtec nightly to help with allergies and sleep. She says it is safe long term but I read that it has been linked to alzheimer’s and other things if taken long term. Can you speak to this?
-Christina
Hi Christina,
Great question. Zyrtec (aka “cetirizine”) is a second-generation antihistamine commonly used for allergies, and it’s often recommended for nighttime use because it can have a mild sedating effect. Unlike older first-generation antihistamines like Benadryl (diphenhydramine), Zyrtec is considered safer for long-term use because it is less likely to cause significant drowsiness or cognitive impairment.
The concern about antihistamines and long-term brain health mainly stems from studies on first-generation antihistamines, which have stronger anticholinergic effects. Anticholinergic drugs block acetylcholine, a neurotransmitter essential for memory and cognitive function. Chronic use of high-anticholinergic burden medications has been linked to an increased risk of dementia, including Alzheimer’s. However, Zyrtec and other second-generation antihistamines have little to no anticholinergic activity, meaning they are not thought to carry the same risks.
That said, long-term use of any medication should be periodically reassessed. If allergies are the main issue, exploring non-medication approaches—such as allergen-proofing your environment, using a HEPA filter, or trying saline nasal rinses—might be worth considering. If you’re taking Zyrtec for sleep, it’s important to recognize that while it may help with falling asleep, it is not a true sleep aid and could affect sleep architecture over time.
I wrote a longer piece about sleep here.
The good news for you now is that based on current evidence, Zyrtec does not appear to have the same long-term cognitive risks as first-generation antihistamines. Sleep tight! 💤
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
After years of dealing with painful, dry and bleeding hands, I may have finally found the answer—O’Keeffe’s Working Hands cream. It’s cheap and it’s mostly sold at hardware stores. It has made a huge difference in just a few days, has no scent and isn’t sticky—just use sparingly!
Thanks for the allergy pill answer I didn’t know I needed. I used Mission Allergy products on our bed and highly recommend. Dust mites are not typically airborne once hygiene is taken seriously. We got the air filters first but didn’t do much good for that and the medical grade covers worked right away. I wash bedding at least every 8th day on hot. I got their comforter for summer because humidity makes activity worse so it’s more severe May - Sept where I live. Lastly, I’m getting allergy shots because I know I don’t want to be on 2 allergy pills a day the rest of my life. I got down to 1 a day but with viral congestion I needed to rule out all allergies and back to 2. Allergy shots are intense at first but so worth it!