How to Know If You Have Nail Pitting

Telltale signs of nail disease

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Nail pitting refers to dents, ridges, or holes in the fingernails or toenails. The dents in the nails can be shallow or deep. It's typically a symptom of another condition, such as psoriasis, an autoimmune disease that causes skin cell overgrowth and buildup.

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What Is Nail Pitting?

Dents, ridges, and holes in the nails can occur due to an issue with how the layers in the superficial nail plate develop. The superficial nail plate is the hard part of the nail that is made up of a type of protein known as keratin, which also makes up your hair and skin. The superficial nail plate protects the skin underneath.

One condition often associated with nail pitting is nail psoriasis. Roughly 50% of people with psoriasis also have symptoms that affect their nails. Nail psoriasis is more likely to affect your fingernails than your toenails.  

Some research has found that people over the age of 40 have nail pitting twice as often as those under 20 years old.

Signs to Look For 

Other nail symptoms of psoriasis may include:  

  • Discoloration of the nail that can be white, yellow, or brown
  • Nails that crumble
  • Nails that separate from the nail bed, or the skin underneath the nail
  • Blood underneath the nails
  • Changes in the shape of the nail or deformation of the nail

How Is the Cause of Nail Pitting Diagnosed?

Your doctor will assess your symptoms as well as take your health history to determine the possible causes of your nail pitting. Even symptoms that you are unsure of may be connected, so it’s important to share all the symptoms you are experiencing along with the ones that are affecting your nails. In some cases, a skin biopsy may be taken to identify any infections or cell abnormalities.

Causes

Although nail pitting can occur in people with psoriasis, research has shown that it is more common in people who have psoriatic arthritis. Psoriatic arthritis typically causes joints to become swollen and inflamed, but it can also cause other symptoms including nail pitting.  

There are many other health conditions that can cause nail pitting. Some of them are skin disorders, while others are not. The health disorders that can lead to the development of nail pitting include:

  • Sarcoidosis: An inflammatory disease that affects multiple organs
  • Pemphigus vulgaris: A rare group of autoimmune diseases that cause blisters on your skin and mucous membranes
  • Alopecia areata: An autoimmune disease that causes the immune system to attack hair follicles
  • Lichen planus: An autoimmune disease that causes inflammation on the skin and inside the mouth
  • Incontinentia pigmenti: A genetic condition that causes skin abnormalities like a blistering rash, wart-like skin growths, and gray or brown patches
  • Reactive arthritis: A type of arthritis that develops because of an infection
  • Atopic and contact dermatitis: Types of eczema that can cause itchiness, rash, and bumps on the skin

Treatment 

In mild cases of nail pitting, treatment may not be required. This is especially true if the nail pitting isn’t causing any discomfort. Medicinal creams are not always effective because they may not reach the nail bed. However, some cases of nail pitting may be treated with vitamin D3 and a corticosteroid, a drug that can help reduce inflammation.

The treatment for nail pitting is done by way of treating the disorder that caused it. In the case of nail psoriasis and psoriatic arthritis, the treatment options are the same since nail psoriasis presents the same in both conditions. Typically, topical or injected corticosteroids are used for moderate cases.  

Medications that affect how the immune system functions, such as synthetic forms of vitamin D (vitamin D analogs) and calcineurin inhibitors, are also often used to help clear up the condition.

In more severe cases of nail psoriasis with nail pitting, biologics therapy is the first-line option. Biologics are medications made from tiny living components such as proteins, sugars, or DNA.

Treatment options for other disorders that can cause nail pitting include:

  • Pemphigus vulgaris: Corticosteroid creams may be used to help reduce inflammation, and immune-suppressing medications are prescribed to help reduce the activity of the immune system, thus decreasing symptoms.
  • Sarcoidosis: Treatment for nail changes in sarcoidosis includes oral corticosteroids, topical steroids, and steroid injections directly into the nail bed. The antimalarial medication hydroxychloroquine sulfate has also been used to help treat nail changes.
  • Alopecia areata: The medications used to address hair loss for people with this disorder may not help with nail pitting. To treat nail pitting and other nail changes for people with alopecia areata, research has shown that immunosuppressants such as Xeljanz (tofacitinib) show promise as a potential treatment.  
  • Lichen planus: The first-line therapy for nail lichen planus is the injection of a synthetic corticosteroid known as triamcinolone acetonide. It can be injected directly into the nails or into a muscle in the body. Retinoids, which act as vitamin A in the body, can also be given orally. In some cases, drugs that suppress the action of the immune system are used.
  • Incontinentia pigmenti: Currently, no specific treatment for this disorder is available. The goal of the management of this disease is to ensure that any lesions that occur do not get infected.
  • Reactive arthritis: Since reactive arthritis is caused by infection, treatment begins with antibiotics. Once the infection is gone, the symptoms should clear up as well. In some cases, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and immune system suppressing medications are used to reduce and manage inflammation.
  • Atopic and contact dermatitis: Contact dermatitis occurs when a person comes into contact with an allergen, so treatment typically involves avoidance and removal of the substance that caused the reaction. For atopic dermatitis, treatment can include topical corticosteroids and immunosuppressants.

Preventing Nail Pitting 

There is no cure for nail pitting, and nothing will prevent it from happening. However, there are things you can do to prevent the symptoms from worsening. Ways that you can keep your nails healthy include:

  • Get prompt treatment for any other conditions you have that could cause nail pitting.
  • Eat a diet rich in vitamins and nutrients.
  • Stay hydrated.
  • Keep your nails short.
  • Wear gloves if you are working with your hands.
  • Avoid getting manicures since they can damage your nails further.
  • Use a good moisturizer on your hands and feet to keep your skin hydrated.
  • Avoid certain triggers of an existing skin disorder, such as smoking, alcohol use, and obesity.

Summary

Nail pitting refers to dents, ridges, and holes in your nails. You may also notice discoloration, buildup or blood under the nails, crumbling nails, and nails separating from your toes or fingers. It's usually a symptom of an underlying autoimmune or skin condition, such as psoriasis, sarcoidosis, and lichen planus. It doesn't require treatment if it's not causing any discomfort. Your doctor may prescribe a corticosteroid or immunosuppressive medications to treat your nail pitting. While it cannot be prevented, maintaining a healthy lifestyle can help prevent your symptoms from getting worse.

A Word From Verywell

Nail pitting can be difficult to cope with because of the embarrassment you may feel. This is especially true for people who work alongside others frequently with their hands or feet uncovered.

The best thing you can do if you have nail pitting is to make an appointment with your doctor. They can determine if you have an underlying health condition that's causing the nail pitting and advise you on what you can do to treat it. Once treatment begins, you are on your way to relief from the discomfort or embarrassment that nail pitting can cause.

Frequently Asked Questions

  • How do I control nail pitting?

    It can be difficult to control nail pitting because the nails continue to grow at a slow pace. If you are experiencing nail pitting, the best thing you can do to get a handle on it is to visit your doctor. They will help determine what is causing it and what treatment will be the most effective for you. In the meantime, you can try to keep your nails as moisturized as possible and avoid any things that may damage them further, such as manicures.

  • How serious is nail pitting?

    If your nail pitting develops because of an underlying health condition, the severity will vary. In most cases, nail pitting isn’t serious and is just a source of cosmetic distress. Severe cases, however, can lead to discomfort and pain that can affect the way you walk and use your hands.

  • Is stress related to nail pitting?

    Stress is a common trigger for psoriasis and other skin disorders, which in turn could trigger nail pitting. Since nail pitting is commonly found in people with nail psoriasis, keeping your stress levels down could help avoid any further nail pitting and other symptoms of your skin disorder.

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