How to Know If You Have Nail Pitting

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.

Read on to learn more about what causes nail pitting, and how these dents in the nail can be treated and prevented.

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.  

Signs to Look For 

Other symptoms 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

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) and Olumiant (baricitinib) 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.

Nail pitting doesn't require treatment if it's not causing any discomfort. Your doctor may prescribe a corticosteroid or immunosuppressive medications to treat it. While it cannot be prevented, maintaining a healthy lifestyle can help prevent your symptoms from getting worse.