Ava Monroe
Pitted fingernails or toenails, also known as nail pitting, are characterised by small indents, depressions, or dimples on the nail surface. It is often associated with psoriasis, an autoimmune condition that causes skin cells to reproduce quickly, leading to thick patches of red skin with silvery-white scales. However, nail pitting can also indicate other conditions such as eczema, arthritis, or genetic factors. While treatments are available, they can be challenging due to the difficulty in reaching the nail bed with topical medications.
| Characteristics | Values |
|---|---|
| Definition | Tiny dents, depressions, or dimples in your fingernails or toenails |
| Appearance | White spots or marks, shallow or deep holes |
| Causes | Psoriasis, eczema, joint inflammation, alopecia, arthritis, dermatitis, autoimmune conditions, deficiencies, hepatitis C, certain drugs, flu shots, some metals and chemicals, genes, family history |
| Treatment | Corticosteroid injections, supplements (vitamin D3), phototherapy, immunosuppressant medications, lifestyle changes, antifungal treatment, steroid injections, removal of the nail, powerful drugs to suppress inflammation |
| Diagnosis | Physical examination, biopsy, medical history |
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What You'll Learn
Pitted fingernails are often linked to psoriasis
Pitted fingernails, or nail pitting, are small dents or dimples that appear in your fingernails or toenails. This condition can be a sign of an underlying health issue, one of the most common being psoriasis.
Nail psoriasis is an autoimmune disease that affects the nails on your fingers and toes. It causes discoloration, pitting, and changes in nail structure. While nail psoriasis is not contagious, it can be a source of embarrassment for those who have it. The condition can cause the nails to become thin and crumble, with the nail bed changing colour and the nail lifting and separating from the finger.
Psoriasis is a skin condition that causes skin cells to reproduce and build up very quickly. It can occur anywhere on the body and tends to come and go. While it is more common to have psoriasis in multiple areas, it is possible for nails to be the only affected body part, although this is rare. This is why nail pitting can be a key indicator of psoriasis elsewhere on the body.
Nail pitting related to psoriasis may show up as shallow or deep holes in the nails, with the pits being as small as a pinhead or as large as the tip of a crayon. The pits can look like white spots or marks, and they can be arranged in haphazard or regular patterns. It is important to note that nail pitting is not always due to psoriasis, as it can also be caused by other conditions such as eczema, dermatitis, or fungal infections.
There are treatments available to help manage nail psoriasis and improve the appearance of pitted nails. These include topical medications, corticosteroid injections, light therapy, and oral medications. In addition, individuals with nail psoriasis can gently buff their nails and apply nail polish to disguise any pits or discolouration.
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Pitting can also be caused by eczema
Pitted nails, or nail pitting, is a condition where small depressions, dimples, or dents appear on the surface of the nail. It can happen on both finger and toenails, although fingernails are more commonly affected. Pitting can be caused by a variety of factors, one of them being eczema.
Eczema is a chronic condition that causes red, dry, and itchy patches on the skin. It can also affect the nails, leading to nail pitting. Pompholyx eczema, which affects the hands and feet, can cause nail pitting and other nail abnormalities. A study found that out of 235 patients aged 2 to 19 with eczema, 16.7% had nail pitting.
Nail pitting due to eczema can manifest as shallow or deep holes in the nails, resembling dents made by a sharp object. It may be uneven and rough, differing from the more uniform patterns seen in other conditions. Additionally, eczema can cause other nail changes, such as thickening, crumbling, and discoloration. These symptoms can be triggered or worsened by contact with allergens like metals, rubber, or leather.
Treating nail pitting associated with eczema is important to prevent the worsening of the condition. Treatment options include managing the underlying eczema and addressing triggers. Protective gloves can be worn to prevent contact with irritants, and topical steroids may be used to treat the affected nails.
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Arthritis is another common cause of nail pitting
Nail pitting, characterised by small depressions or dimples in the fingernails or toenails, can be caused by several factors, including arthritis. Psoriatic arthritis, an inflammatory type of arthritis, is the most common form associated with nail pitting. It affects up to 90% of people with this condition and can cause pitting, discoloration, and brittle nails.
Psoriatic arthritis is a type of inflammatory arthritis that occurs in some individuals with psoriasis, a skin condition that causes the overproduction of skin cells, resulting in dry, red patches with thick silvery scales. The inflammation associated with psoriatic arthritis can affect the matrix, the area at the base of the nail responsible for new nail growth. This inflammation leads to the formation of grooves and ridges known as Beau's lines, which run lengthwise across the nails.
The inflammation in the nail matrix can also cause nails to grow too quickly or become thickened. Over time, long-term inflammation can result in nail crumbling, and nails may start to separate from the nail bed, a condition called onycholysis. Discolouration, such as white, yellow, or brown spots, and reddish marks from tiny burst blood vessels under the nails, are also common among people with psoriatic arthritis.
The treatment for nail pitting due to psoriatic arthritis aims to manage the underlying condition and relieve associated pain. Topical treatments, such as medicated creams, ointments, or nail polishes, can be used, but their effectiveness is limited by their inability to penetrate the nail bed easily. Oral medications, including methotrexate, cyclosporine, or apremilast, may be prescribed in more severe cases. Injections of corticosteroids or medicines like etanercept, adalimumab, or ustekinumab, directly into the skin around the nails are another option to treat nail pitting.
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Hepatitis C, certain drugs, and some metals/chemicals may trigger pitting
Pitting, which manifests as small depressions in the nail plate, is usually associated with psoriasis, affecting 10 to 50 percent of patients with this condition. However, it can also be caused by other systemic diseases, including Reiter’s syndrome, connective tissue disorders, sarcoidosis, pemphigus, alopecia areata, and incontinentia pigmenti. Any localized dermatitis, such as atopic or chemical dermatitis, that disrupts the orderly growth of the nail plate can also result in pitting.
In the context of pitted fingernails, it is important to consider the potential role of Hepatitis C, a liver disease that is known to be associated with various skin disorders. Research has shown that nail abnormalities are prevalent in patients with Hepatitis C, with 68% of individuals in one study exhibiting nail changes. These nail alterations can serve as additional criteria to help identify systemic diseases like Hepatitis C.
Furthermore, certain medications have been linked to nail-related side effects, and in rare cases, these can include pitting. For example, anti-seizure medications, blood thinners (anticoagulants), and lithium (used to treat bipolar disorder) have all been associated with nail changes. It is important to note that most drug-induced nail changes are cosmetic and harmless, but some may require medical intervention.
Additionally, exposure to certain metals or chemicals can contribute to nail pitting. Koilonychia, or "spoon-shaped" nails, can be indicative of iron deficiency or anemia. In some cases, it may also be associated with occupational exposure to petroleum-based solvents. Therefore, individuals working in industries where such chemicals are commonly used may be at a higher risk of developing nail pitting.
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Pitted nails can be treated with medication and lifestyle changes
Pitted nails, or nail pitting, is characterised by small depressions or dimples in the fingernails or toenails. It is often related to nail psoriasis, an autoimmune condition that causes skin cells to reproduce quickly, resulting in discolouration, pitting, and changes in nail structure. While there is no cure for nail psoriasis, various treatments can help manage symptoms and prevent the condition from worsening.
Medications
Oral and topical medications can be used to treat pitted nails, especially when caused by nail psoriasis. Topical corticosteroids, for instance, can be applied once or twice daily to address most symptoms of nail psoriasis. Calcipotriol, a medication derived from vitamin D, is also used to treat buildup under the nails. Tazarotene, a derivative of vitamin A, can be applied to treat pitting, nail separation, and discolouration. However, it may irritate the surrounding skin, so it's important to follow a dermatologist's instructions when using this medication.
In more severe cases, corticosteroid injections may be recommended. Immunosuppressant medications, such as cyclosporine (Neoral) and methotrexate (Trexall), are also treatment options. However, these medications are typically not the first choice due to potential side effects. Doctors may also suggest vitamin D3 supplements to help manage symptoms.
Lifestyle Changes
Lifestyle changes can also help manage pitted nails, especially when triggered by stress or underlying health conditions. Keeping dermatology appointments can aid in early detection and treatment, preventing the condition from worsening. Additionally, maintaining nail hygiene is important. Nails should be regularly cleaned, trimmed, and moisturised to keep them healthy and reduce the chances of infection.
For those who feel self-conscious about the appearance of their nails, gentle buffing and the application of nail polish can help disguise pits and discolouration. However, it is important to avoid using fake nails, as they can damage natural nails.
While treatments are available, it is important to note that treating nail pitting can be challenging and may not always yield the best results. It is a long-term process that requires guidance from a healthcare professional to find the most effective approach for each individual.
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Frequently asked questions
Pitted fingernails are small dents, depressions, or dimples in your fingernails or toenails.
Pitted fingernails are often linked to psoriasis, an autoimmune condition that causes skin cells to reproduce quickly. However, they can also be caused by alopecia, eczema, arthritis, or even your genes.
Treating pitted fingernails can be difficult because the pits form as your nail grows. Treatment options include corticosteroid injections, oral medications, phototherapy, and lifestyle changes.
