Ava Monroe
Holes in fingernails can be caused by several factors, including nail injuries, underlying medical conditions, and skin disorders. In terms of injuries, holes can be caused by trauma to the nail, such as catching your finger in a door or hitting it with a heavy object. This can result in a subungual hematoma, which is blood under the nail, or even a nail fracture. In terms of medical conditions, holes in the nails can be a symptom of nail pitting, which is often associated with nail psoriasis, autoimmune conditions, or dermatitis. Nail pitting causes small pits or depressions in the nails and can be challenging to treat due to the slow growth of nails. Other causes of holes in the nails include infections, such as fungal infections, which can thicken the nail and cause discoloration.
| Characteristics | Values |
|---|---|
| General Term | Nail Pitting |
| Synonyms | Nail Denting, Nail Trauma |
| Description | Small pits, depressions, dimples, ridges, or holes in the fingernails or toenails |
| Severity | Shallow or Deep |
| Direction | Horizontal or Vertical |
| Location | Fingernails or Toenails |
| Frequency | One or Multiple Pits |
| Color | White, Yellow, or Brown |
| Texture | Chalk-like or Raised |
| Symptoms | Discoloration, Abnormal Growth, Nail Separation, Crumbling, Thickening, Discomfort, Distress, Loss of Functionality |
| Causes | Nail Psoriasis, Autoimmune Conditions, Deficiencies, Dermatitis, Skin Cell Overgrowth, Buildup, Injury, Infections, Illnesses, Trauma |
| Treatment | Corticosteroid Injections, Supplements, Topical Medications, Lifestyle Changes, Antifungal Treatment, Nail Removal, Stitches, Splint, Salicylic Acid, Calcipotriol, Tazarotene |
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What You'll Learn
Nail pitting
Other potential causes of nail pitting include autoimmune conditions like alopecia areata, sarcoidosis, and pemphigus vulgaris, as well as connective tissue disorders such as Reiter's syndrome and osteoarthritis. Dermatological conditions, particularly dermatitis, can also lead to nail pitting. Examples of dermatitis include atopic dermatitis and contact dermatitis.
Treating nail pitting can be challenging due to the difficulty in reaching the nail bed with topical medications. However, there are several treatment options available, including corticosteroid injections into the nail bed, oral or topical medications, phototherapy or light therapy, and immunosuppressant medications. Lifestyle changes and vitamin D3 supplements may also be recommended by a doctor.
If you notice pitting in your nails, it is advisable to consult a doctor. They will assess your medical history, perform a physical examination, and may perform a skin biopsy to determine the underlying cause of the nail pitting.
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Dermatitis
One type of dermatitis is atopic dermatitis, which is a common skin disease characterised by chronic, relapsing forms of skin inflammation from a disturbance of epidermal-barrier function that results in dry skin. It is known to be one of the main predisposing factors for chronic hand and foot eczema. Eczema on the hands is common, and fingernail changes are more common than toenail changes. When eczema affects the hands and feet, it is called pompholyx eczema. Pompholyx eczema can affect the nail folds and skin around the nails (cuticles), resulting in swelling.
Nail dystrophy is associated with atopic dermatitis and its severity. Different nail dystrophies occur depending on the nail area affected. Eczematous change infiltrating the nail matrix can cause anonychia, nail pitting, trachyonychia, longitudinal ridges, transverse groove (Beau's line), onychomadesis, and onychoschizia. Damage to the nail bed can cause brachyonychia, chromonychia, clubbing, koilonychia, subungual exostosis, yellow nail syndrome, onycholysis, and splinter haemorrhage. Beau's line is caused by decreased function of the proximal nail matrix, and if the dysfunction persists over a few weeks, onychomadesis can also appear.
Nail pitting is a common symptom of dermatitis. It can manifest as small depressions or dimples in the fingernails or toenails. Nail pitting can be caused by autoimmune conditions, deficiencies, and dermatitis. It can be treated with medications, topical medications, and lifestyle changes. Treating nail pitting can be challenging because the pits are formed as the nail grows, and topical medications cannot easily reach through the nail bed. Therefore, doctors may recommend corticosteroid injections into the nail beds.
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Nail trauma
If you experience a nail injury, make sure your tetanus vaccination is up to date. If there is blood under the nail, this could indicate an underlying bone fracture or tissue tear, and a doctor should evaluate the injury. If the trauma affects the nail matrix (the tissue inside the cuticle where new nail is formed), a ridge or split can develop. However, if the matrix heals normally, the deformity will disappear as the nail regrows.
Treatment for a subungual hematoma (blood under the nail) involves relieving pressure by draining the blood. This can be done at home for a small hematoma by heating a needle and using it to create a small hole for the blood to drain through. For more serious injuries, a doctor may need to remove the nail and repair the nail bed. Antibiotics may be prescribed to prevent infection.
Nail biting is a common cause of acute paronychia, a type of bacterial infection that causes swelling and irritation. Other subconscious habits, such as picking objects with the nail or prying the eponychial fold, can also lead to nail deformities.
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Nail bed injury
Nail bed injuries are common, with fingertip injuries being the most frequently seen hand injuries. The fingertip is the most vulnerable to injury because it is the point of interaction between the body and its surroundings in most daily activities. Most injuries of the nail bed are due to crushing injuries, such as being hit with a hammer or having the finger crushed in a doorway. In addition to long-term cosmetic consequences, injuries to the nail can affect daily living. The nail provides protection for the fingertip, the ability to pick up small objects, and plays a role in tactile sensation.
There are several types of nail bed injuries. A subungual hematoma looks like a bruise and forms when small blood vessels under the nail bed leak, and blood pools between the nail and the nail bed. This usually occurs when the tips of the fingers or toes are crushed or subjected to a heavy impact. As the blood accumulates in the small space beneath the nail, it puts pressure on the tender skin of the nail bed, and sometimes the nail lifts away from the nail bed. Another type of nail bed injury is a cut, or laceration, that pierces the nail and nail bed beneath. Crush and avulsion injuries, as well as injuries associated with distal phalanx fractures, have a worse prognosis. Blunt trauma to the fingertip and nail bed requires adequate treatment to prevent secondary deformities and reduce the need for subsequent reconstruction.
Home remedies and medical treatments can help with minor nail bed injuries, including subungual hematomas, which often heal on their own, especially when no other injuries are present. Bandages and ice packs can help treat these injuries, and prompt treatment can help the nail bed and underlying structures heal and ensure that the broken nail grows back smoothly. Antibiotics may be needed to prevent infection, and doctors may also check on the status of tetanus injections and request an X-ray to check for bone fractures. Depending on the severity of the injury, it may take 6-9 months to fully recover, and the nail may still grow back with small ridges or bumps.
Nail pitting, or small depressions or dimples in the fingernails or toenails, can also be considered a type of nail bed injury. It is often related to nail psoriasis, but autoimmune conditions, deficiencies, and dermatitis can also cause nail symptoms. Treating nail pitting can be difficult because the pits are formed as your nail grows, and topical medications are unable to easily reach through the nail bed. Corticosteroid injections into the nail beds may be considered.
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Psoriasis
Holes in the fingernail, or nail pitting, can be caused by several conditions, including nail psoriasis. Psoriasis is a common skin condition that causes inflammation of the skin and often leads to patches of red, scaly skin. It is not infectious, cannot be passed on, and does not develop into cancer. It can develop at any time, but it most commonly starts in people aged between 15 and 35.
Nail psoriasis is an autoimmune disease where the immune system overreacts, leading to new skin cells growing too fast. It causes discoloration, pitting, and changes in your fingernails and toenails. It is more likely to affect your fingernails than your toenails. The skin underneath your nails (nail bed) may change colour, with salmon patches or oil drop spots appearing yellow, red, pink, or brown. Pitting can manifest as dents or pits, ranging from pin-sized to crayon-tip-sized, and can be shallow or deep. Nails may also develop grooves that run horizontally (Beau's lines), and they may grow so thin that they start to crumble. The thick layer of skin underneath the tip of the nail may also start to peel and slowly separate from the nail bed (onycholysis), which may lead to a nail fungal infection.
Nail psoriasis is typically graded using the nail psoriasis severity index (NAPSI), which divides the nail into four sections and assigns a score based on the presence of symptoms. Treatment options for nail psoriasis include corticosteroid injections or ointments, oral medicines, and medicine injections such as etanercept, adalimumab, or ustekinumab. While there is no cure for nail psoriasis, treatments can help alleviate symptoms.
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Frequently asked questions
There are several reasons why you might have holes in your fingernails, a condition known as nail pitting. One of the most common causes is psoriasis, but it can also be caused by autoimmune conditions, deficiencies, dermatitis, or fungal infections.
Treatment for nail pitting can be challenging because the pits are formed as your nail grows. Topical medications are often ineffective as they cannot reach through the nail bed. Treatments include steroids, salicylic acid, calcipotriol, and tazarotene. In more severe cases, steroids can be injected into the nail bed, or the nail can be removed with ointment or surgery.
If you have injured your nail bed, you should first remove any jewellery from your hands and gently wash the injury. If it is a minor injury, you may be able to treat it at home. If the injury is more serious, such as a deep cut or a subungual hematoma that covers more than 25% of your nail, you should see a doctor.
If you have a nail injury, you should see a doctor if you are unable to remove rings from swollen fingers, if the injury is bleeding and will not stop, or if there is blood under the nail that occupies more than half of the nail area, as this could indicate a fracture or tissue tear.
To prevent nail pitting, you should take care when performing manual labour by wearing gloves to protect your hands and nails. You should also avoid cleaning your nails with sharp objects or brushes, and instead soak them in warm water to remove debris.
