Noah Sinclair
Pitted fingernails, or nail pitting, can be a symptom of several underlying health conditions. It is characterised by small dents, dimples, or depressions in the fingernails or toenails, which may be accompanied by discolouration and abnormal growth. While the exact causes of nail pitting are varied, it is often associated with nail psoriasis, an autoimmune condition that affects the fingernails and toenails. In this article, we will explore the various causes of pitted fingernails and discuss the treatment options available.
| Characteristics | Values |
|---|---|
| Common Causes | Psoriasis, arthritis, atopic dermatitis, alopecia areata |
| Less Common Causes | Pemphigus vulgaris, lichen planus, incontinentia pigmenti, sarcoidosis, reactive arthritis, anemia |
| Treatment Options | Corticosteroids, biologics, vitamin D analogs, calcineurin inhibitors, immunosuppressants, retinoids |
| Prevention | No known prevention |
| Associated Conditions | Psoriatic arthritis, nail fungus, heart attack, high cholesterol |
| Symptoms | Small dents, depressions, dimples, discoloration, abnormal growth, crumbling, loose nails, nail separation from nail bed |
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Psoriasis
Nail pitting is a common symptom of psoriasis, affecting 7% to 40% of people with the condition. It can manifest as shallow or deep holes in the nails, resembling white spots or marks. Psoriasis can also cause nail thickening, crumbling, or onycholysis, where the nail separates from the underlying nail bed. These nail changes are most common in people with psoriatic arthritis, a type of arthritis associated with psoriasis.
The exact cause of nail psoriasis is unclear, but it is believed to be influenced by multiple factors, including genetic, immunological, and environmental factors. While there is no way to prevent nail psoriasis, treatments are available to reduce symptoms and manage the condition. Treatment options include prescription and over-the-counter medications, such as corticosteroid creams, ointments, or nail polish, as well as oral medicines and injections in more severe cases.
It is important to note that nail changes might not be the first symptom associated with psoriasis, and they can impact a person's social and psychological well-being. If you notice any nail pitting or other nail abnormalities, it is recommended to consult a healthcare professional for diagnosis and appropriate treatment. They can rule out other underlying conditions and provide guidance on managing the condition effectively.
Additionally, while treating nail psoriasis, it is advised to regularly clean, trim, and moisturize your nails, and protect them from harm. In terms of cosmetic solutions, you may gently buff your nails and apply nail polish to hide any pits or discolouration. However, it is important to avoid using fake nails as they can damage your actual nails.
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Alopecia areata
Pitted fingernails, or nail pitting, can be a symptom of several conditions, including alopecia areata. Alopecia areata (AA) is an autoimmune disease that causes temporary or permanent hair loss. It affects the nails in up to 46% of those affected, with nail involvement reported in 64.1% of patients in one study. The most common nail manifestations of AA include pitting, which occurs in 29.7% of patients, trachyonychia (18%), and leukonychia.
Nail pitting in AA can appear as small dents, depressions, or dimples in the fingernails or toenails. It can also be accompanied by splitting, crumbling, and white spots. The depth and width of the nail pits is related to the extent of the matrix involved, while the length of the pits can be influenced by the duration of the matrix damage.
The presence of nail changes in AA can be a poor prognostic factor, indicating more severe disease. However, it's important to note that nail-related quality of life is only minimally affected by these nail changes. While there is currently no consensus on the optimal treatment approach for AA of the nails, the emergence of JAK inhibitors shows promise for hair regrowth, and new topical formulations may improve safety, especially for vulnerable populations.
If you notice pitted fingernails or other nail changes, it is important to consult a healthcare provider. They can administer tests to rule out underlying conditions and provide appropriate treatment options.
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Pemphigus vulgaris
Pemphigus is a rare disease that causes blistering of the skin and mucous membranes, such as the inside of the mouth, nose, throat, eyes, and genitals. Pemphigus vulgaris is the most common type of pemphigus worldwide and normally affects the mucous membranes, although it can also affect the skin. It is caused by a problem with the immune system, which mistakenly attacks healthy skin cells instead of fighting off infections. This results in the disruption of the bonds between skin cells, causing the skin to become fragile and blisters to form.
While there is no cure for pemphigus vulgaris, it can be controlled with medications in many cases. Treatment options include corticosteroids, medicine injections, and oral medicines. It is important to repeat the treatment if the blisters come back and to take steps to ease the symptoms and reduce the risk of further complications. Some recommended steps include using a soft toothbrush and mint-free toothpaste, avoiding mouthwashes that contain alcohol, and keeping sore patches clean to prevent infection. It is also crucial to avoid activities that could damage the skin, such as contact sports, if blisters are present.
Certain risk factors increase the likelihood of developing pemphigus vulgaris. These include ethnic background, with people of Jewish (particularly Ashkenazi), Indian, Southeast European, or Middle Eastern descent being more susceptible. Women are also slightly more likely to develop the disease than men, and the age of onset is typically between 50 and 60 years old, although symptoms may begin earlier in certain geographical areas. Genetic factors are believed to play a role, as certain variants in immune system genes have been linked to a higher risk. Additionally, medications such as certain antibiotics and blood pressure drugs have been associated with pemphigus vulgaris in rare cases.
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Lichen planus
Skin
On the skin, lichen planus causes a rash that is usually itchy. The most common symptoms are shiny, red or purple bumps that may be accompanied by fine white lines or scales. The rash can also be scaly and pruritic. In rare cases, it can present as violaceous plaques with a central clearing, often involving the penis, scrotum, and intertriginous areas.
Mouth
Scalp
On the scalp, lichen planus can cause redness, irritation, and tiny bumps. It may also lead to hair thinning and hair loss.
Genitals
Nails
The cause of lichen planus is usually unknown, but it is believed to be an autoimmune disorder in which inflammatory cells attack an unknown protein within the skin and mucosal keratinocytes. Certain medications, injuries to the skin, viral infections, and allergies may also contribute to lichen planus.
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Incontinentia pigmenti
The disease is characterised by skin abnormalities that begin in childhood, usually a blistering rash that heals, followed by the development of harder skin growths. In infancy and early childhood, the skin develops grey or brown patches (hyperpigmentation) that occur in a swirled pattern. These patches, which can occur anywhere on the body, fade with time. Adults with incontinentia pigmenti usually have lines of unusually light-coloured skin (hypopigmentation) on their arms and legs. The discoloured skin is caused by excessive deposits of melanin (the normal skin pigment). Most newborns with IP will develop discoloured skin within the first two weeks. The pigmentation involves the trunk and extremities and is distributed in irregular marbled or wavy lines.
There is no specific treatment for incontinentia pigmenti. The main goal is to prevent secondary bacterial infection of skin lesions and to monitor closely the development of related problems. This should include regular dental care and close monitoring by an ophthalmologist for the first few years of life.
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Frequently asked questions
Pitted fingernails are small dents, dimples, or depressions in the nails, as if an ice pick had hit them. They can vary in frequency from small, irregularly spaced depressions on one or more nails to the regular uniform pitting of all nails.
One of the most common causes of pitted fingernails is psoriasis, an autoimmune condition that affects the fingernails and toenails. Other causes include atopic dermatitis, alopecia areata, and arthritis.
Treatment for pitted fingernails involves treating the underlying disorder that caused it. In the case of nail psoriasis, treatment options include injected or topical corticosteroids, oral medications, and biologics therapy.
A rash can indicate a number of conditions, including psoriasis, dermatitis, and pityriasis rosea. It is important to see a healthcare provider to diagnose and treat the underlying cause of the rash.
