Liam Carter
Holes in fingernails, also known as nail pitting, can be caused by several conditions, including nail psoriasis, an autoimmune disease that causes skin cells to reproduce quickly, leading to inflammation and patches of red, scaly skin. Nail pitting can also be caused by other dermatological conditions, such as dermatitis, or vitamin and nutrient deficiencies. In some cases, injuries to the nail, such as accidentally slamming a finger in a door, can also result in nail pitting. While treatment can be challenging, options include corticosteroid injections, oral medications, and lifestyle changes.
| Characteristics | Values |
|---|---|
| General Term | Nail Pitting |
| Other Names | Nail Denting, Cupuliform Depressions |
| Description | Small pits or depressions on the surface of the nail |
| Pit Size | 0.4-2 mm |
| Number of Pits | 1-10+ per nail |
| Location | Fingernails, Toenails |
| Prevalence | More common on fingernails than toenails; more common in people over 40 |
| Associated Conditions | Psoriasis, Psoriatic Arthritis, Dermatitis, Autoimmune Conditions, Deficiencies |
| Symptoms | Discoloration, Abnormal Growth, Nail Crumbling, Nail Separation (Onycholysis), Subungual Hyperkeratosis, Nail Fungus |
| Treatment | Corticosteroid Injections/Cream/Ointment/Nail Polish, Medicine Injections, Oral Medicines, Lifestyle Changes |
| Diagnosis | Physical Exam, Skin Biopsy, Nail Psoriasis Severity Index (NAPSI) |
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What You'll Learn
Psoriasis
Holes in your fingernails could be a result of nail pitting, which is often related to nail psoriasis. Psoriasis is an autoimmune condition that causes skin cells to reproduce quickly. Typically, new skin cells grow every 28 to 30 days, but in people with psoriasis, new cells grow and move to the skin surface every three to four days, creating a skin rash.
Nail psoriasis is a common condition, affecting over 50% of people with psoriasis and around 86% of people with psoriatic arthritis. It can cause discoloration, pitting, and changes in your fingernails and toenails. The pitting can manifest as tiny dents or pinprick holes, ranging from 0.4 to 2 millimetres in size, and can be shallow or deep. Discoloration may appear as yellow, red, pink, or brown spots, known as salmon patches or oil drop spots. In severe cases, nail psoriasis can lead to nail separation from the nail bed (onycholysis) and even cause nails to crumble.
While there is no cure for nail psoriasis, treatments can help alleviate symptoms. Good nail care is essential for managing the condition. Treatment options include phototherapy, systemic medications, biologics, and topical drugs such as corticosteroids, vitamin D, or retinoid creams.
It is important to note that other conditions can also cause nail pitting. These include autoimmune conditions, deficiencies, dermatitis, and dermatologic conditions that cause skin cell overgrowth and buildup. Beau's lines, for example, can appear as moat-like depressions on the nail and may be triggered by illnesses, infections, injuries, or skin conditions. Therefore, it is advisable to consult a doctor for an accurate diagnosis and appropriate treatment plan.
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Dermatitis
Holes in the fingernails, or nail pitting, can be caused by various dermatologic conditions, including dermatitis. Dermatitis refers to the inflammation of the skin, and there are several types, including atopic and contact dermatitis.
Nail dystrophy, or abnormalities in the nails, can be caused by various inflammatory dermatologic diseases, including atopic dermatitis (AD). In patients with AD, nail abnormalities are thought to be caused mainly by pathologic changes in the nail matrix region. Nails often reflect the pathologic features of adjacent tissue, and various nail diseases are found in about 10% of patients visiting dermatologic clinics.
Nail pitting can be a symptom of nail psoriasis, an autoimmune condition that affects the nails on both fingers and toes. It is characterised by discoloration, pitting, and changes in the shape of the nails. Psoriasis causes skin cells to reproduce quickly, leading to abnormal growth and pitting in the nails. While nail psoriasis is commonly associated with nail pitting, it is important to note that not all cases of nail pitting are due to psoriasis, as other factors can also contribute.
Other causes of nail pitting include autoimmune conditions, deficiencies, and skin conditions like eczema. In some cases, injuries that damage the nail matrix, such as accidentally slamming a finger in a door, can also lead to nail pitting. Additionally, certain illnesses and infections, such as COVID-19, strep throat, and pneumonia, can disrupt nail growth and contribute to nail pitting.
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Autoimmune conditions
Holes in the fingernails, also known as nail pitting, can be caused by various dermatological conditions and autoimmune diseases. Autoimmune diseases occur when the immune system malfunctions and attacks healthy tissues and organs, in this case, the nails. While there are over eighty types of autoimmune disorders, a few that are known to cause nail deformities include:
Psoriasis
Nail psoriasis is an autoimmune disease that causes skin cells to reproduce quickly, leading to inflamed patches on the skin. It is characterised by nail pitting, discolouration, and changes in nail structure. The pits can vary in size and depth, and the condition can affect both the fingernails and toenails. While there is no cure for nail psoriasis, treatments are available to alleviate symptoms.
Hashimoto's Disease
Hashimoto's disease is the most common cause of low thyroid-hormone production, which can result in hair loss, puffy face, and nail abnormalities such as crumbling, splitting, thinning, or spoon-shaped nails. It is more common in women, and the risk increases if the individual already has another autoimmune disorder.
Vitiligo
Vitiligo is an autoimmune disease that causes the loss of melanin in the skin. As a result, the skin, hair, and nails may lose their colour. It affects all races but may be more noticeable in individuals with darker skin tones.
Lupus
Lupus is an autoimmune disease that can cause various symptoms, including hair loss, rashes, and nail deformities. It is important to consult a dermatologist for an accurate diagnosis and to limit the spread of the disease.
It is always advisable to consult a medical professional for a proper diagnosis and treatment plan if you notice any abnormalities in your nails or experience other concerning symptoms.
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Deficiencies
Fingernail holes, also known as nail pitting, can be caused by several factors, including deficiencies, dermatological conditions, and autoimmune diseases. While nail pitting is often associated with nail psoriasis, deficiencies in certain vitamins and nutrients can also contribute to this condition.
Vitamin and nutrient deficiencies can impact nail health and growth, leading to the formation of holes in the fingernails. For example, a lack of zinc in the body can result in nail pitting. Zinc is an essential mineral that plays a crucial role in maintaining the health of the nails, skin, and hair. A deficiency in zinc can cause changes in the nail structure, such as pits or ridges. Ensuring adequate zinc intake through diet or supplements may help prevent or improve nail pitting associated with zinc deficiency.
Protein deficiency is another potential cause of fingernail holes. Protein is a vital component of nail structure, as the nail plate, or the hard, outer part of the nail, is primarily composed of a protein called keratin. When the body does not receive sufficient protein, it can affect the growth and structure of the nails, leading to nail pitting and other abnormalities. Consuming an adequate amount of protein through dietary sources or supplements can help address this deficiency and promote healthier nails.
While less common, deficiencies in other vitamins and minerals can also contribute to nail pitting. For example, a lack of vitamin B12 or iron can result in brittle nails that are more susceptible to breakage and the formation of holes. Additionally, biotin, also known as vitamin B7, plays an important role in nail health, and a deficiency can lead to brittle nails and nail pitting. Addressing these deficiencies through dietary changes or supplements may help improve nail health and reduce the occurrence of holes in the fingernails.
It is important to note that nail pitting can have various causes, and a combination of factors may be at play. If you are experiencing persistent or severe nail pitting, it is advisable to consult a healthcare professional. They can assess your symptoms, consider your medical history, and perform any necessary tests to determine the underlying cause of your fingernail holes. Based on the diagnosis, your healthcare provider can recommend appropriate treatments or lifestyle changes to improve your nail health and address any underlying deficiencies.
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Nail injuries
When a nail injury occurs, the nail, nail bed (skin underneath the nail), cuticle (base of the nail), or the skin around the nail may be affected. The injury could be a cut, tear, smash, or bruise, and in some cases, the nail may be torn away from the skin. For minor nail injuries, such as a small nail bruise, you can treat it at home by removing any jewellery from the injured finger and applying soap to help slide off any rings. However, if your finger is swollen and you cannot remove a ring, it is important to seek medical help.
More serious nail injuries may require a visit to an urgent care centre or emergency room. Treatment at a medical facility will involve stopping the bleeding and cleaning the wound. The medical provider may numb the injured area with medicine before treating it. In the case of a large bruise, a small hole may be created in the nail to drain blood and fluid, relieving pressure and pain. If the bone is fractured or the bruise is extensive, the nail may need to be removed, and the nail bed repaired with stitches or special glue. In some cases, the nail may not be reattached, and a special type of material may be used to cover the nail bed during the healing process. Antibiotics may be prescribed to prevent infection, and a wire may be placed in the finger to stabilise a broken bone.
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Frequently asked questions
Holes in your fingernails, also known as nail pitting, can be caused by several things. The most common cause is nail psoriasis, an autoimmune condition that affects the speed at which skin cells reproduce. Other causes include dermatitis, deficiencies, and other autoimmune conditions.
Nail pitting can appear as small pits on the surface of the nail, ranging from pin-tip-sized to crayon-tip-sized. These pits can be shallow or deep and can appear alone or in groups.
Nail psoriasis can cause discolouration, changes in nail structure, and crumbling nails. It is often associated with a psoriatic rash on other parts of the body.
Treatment for nail pitting can be challenging due to the difficulty of delivering medication through the nail bed. Topical treatments are available, but for more serious cases, corticosteroid injections or oral medications may be required.
If you notice pits on your nails, it is recommended that you consult a doctor. They will be able to assess your symptoms and perform a physical examination to determine the underlying cause.
