Nail Pitting Those Have you ever noticed little dips or holes on the surface of your nails? They are nearly as though someone had poked them with a pin. The majority of people just wave it off. However, here is the startling fact: the tiny dents do have a name, and it carries a meaning. Nail pitting is a medical condition, and this can be one of the early signs that something is happening inside your body. Being aware of it might even assist you in preventing a health problem that is bigger and more troublesome to handle.
What Is Nail Pitting?: Nail Pitting Those
So, what is nail pitting, exactly? Nail pitting simply refers to the fact that your fingernails or toenails have little depressions, dents, or small holes on them. The size and depth of these pits may be different. Some are so shallow and hardly noticeable, and others so deep as to be easily seen.Psoriasis of the nail: a review of the literature with a focus on therapy.Journal of the American Academy of Dermatology. 2007;57(1):1–27.” style=”position:relative;color:#309b65;cursor:help;border-bottom:1px dotted #309b65;font-weight:bold”>[1]
It is a crucial difference here: nail pitting is not the similarity of a scratch or dent obtained as a result of banging your finger. A bodily injury to the nail usually fades and matures in the long run. Nail pitting, on its part, continues to develop with nail growth. It is not brought about by any exterior injury; it is brought about internally, right at the location of nail formation (this is referred to as nail matrix). It is what makes it a medical symptom worth paying attention to.
Pitting occurs due to focal defective keratinization in the proximal nail matrix. Development of the outermost layer of the nail plate, the majority of which is composed of keratin, the tough protein of the skin and hair, is interrupted, resulting in the formation of the pits. In case of poor formation of this layer, small holes or depressions are left as the nail grows out.
What Causes Nail Pitting?
The most common question that most individuals raise is what is the cause of nail pitting? The response is that it is nearly always an indicator of a pre-existing condition. The nails, just as the eyes, can be a window to what is going on in deeper parts of the body. Let’s look at the main causes.
1. Psoriasis
Nail pitting psoriasis is by far the most prevalent cause, which is reported in medical literature.[2] Psoriasis is an autoimmune disease that is long-term in nature, in which the immune system confuses normal skin cells, multiplying them unnecessarily. When the process impacts the nail matrix where the nails grow beneath the skin, it results in pitting, discolouring, thickening, and even nail separation (also referred to as onycholysis, where the nail and nail bed separate).
Psoriasis on the nail can cause small pits, ridges, and surface irregularities.
It has been proven that nail pitting affects up to half of psoriasis patients. The nail pitting is the most frequent nail symptom in an individual with psoriatic arthritis (a joint condition associated with psoriasis). However, strangely enough, the nail changes may manifest themselves when a person has no visible skin symptoms; pitted nails should be considered a significant early warning.
2. Alopecia Areata
Alopecia areata is an autoimmune disease that is mostly characterized by patchy loss of hair. But it can also affect the nails. The pitting that occurs in alopecia areata is finer and geometric in nature, where it usually occurs in smooth rows as compared to the coarse, disordered pitting of psoriasis.[3]
3. Eczema and Dermatitis
Pitting of the nail may be brought about by eczema (also known as atopic dermatitis) when the skin adjacent to and beneath the nail is inflamed. With these, the pitting at such cases can appear more irregular and rough than when it appears with psoriasis or alopecia.[4]
4.Lichen Planus
It is a disorder of swelling and irritation of the skin, hair, nails, and mucous membranes. Scientists are not completely certain about its triggering factors, but hepatitis C, some drugs, some metals, and chemicals are suspected. Nail pitting is also a known characteristic of the condition.[5]
5. Reactive Arthritis
Previously known as Reiter syndrome, reactive arthritis occurs following a bacterial infection of the intestines, genitals, or urinary tract. It may produce inflammation of the joints and, in others, nail pitting. It is not as frequent as other causes, but it is worth mentioning.[6]
6. Nutritional Deficiencies
Nail abnormalities (including pitting) have been associated with deficiency of iron, folic acid, zinc, and biotin (a B vitamin). Although nutritional deficiency is hardly the main reason behind severe nail pitting, it may aggravate the condition and the general nail health.[7]
7. Rare Conditions
Nail pitting has also been associated with rarer conditions, such as:
Fingernails and Disease: What the Nails Say?
The concept of fingernails and disease association is nothing new in medicine. Physicians were very attentive to changes in nails as a diagnostic indication long before blood tests and imaging technology. The tradition still exists today, and with good reason.[8]
A rapid comparison of what these changes in the nails can indicate would be the following:
| Nail Change | Possible Underlying Condition |
|---|---|
| Pitting (small dents) | Psoriasis, alopecia areata, eczema |
| Yellow, thickened nails | Lung disease, lymphedema |
| Spoon-shaped nails (koilonychia) | Iron deficiency anemia |
| White nails (Terry’s nails) | Diabetes, Liver disease, and heart failure. |
| Horizontal ridges (Beau’s lines) | Disease, infection, malnutrition. |
| Clubbed nails | Lung or heart disease, low blood oxygen |
| Dark streak under nail | Possible subungual melanoma |
This table is an explanation of why you have to be attentive to your nails more than a cosmetic issue. Alteration of the nails may be one of the earliest signs of disease in the body.
The Difference Between Ridges on Fingernails and Nail Pitting
The ridges on fingernails are commonly mixed with nail pitting, and thus, we will clear that. The ridges are formed as a line which runs either lengthways (vertically) or across the nail (horizontally). Vertical ridges are very frequent and may be a normal result of aging. Horizontal ridges are, however, either an indicator of disease or a lack of nutrition.[9]
Pitting, on the other hand, is a depression or holes on the surface of the nails, but not uplifted lines. The two may occasionally be observed to coexist, especially in psoriasis, where nails are likely to exhibit pits as well as surface ridging, among other alterations such as crumbling, thickening, or change of colour. The difference in knowing assists patients and clinicians in reducing the probable cause.
What Do Pitted Nails Look Like?
Pitted nails may be either very subtle or very dramatic. Here’s what to watch for:
Nail pitting can affect several nails and may be linked to psoriasis.
- Small, shallow dimples that look like pinpricks across the nail surface
- The deeper holes are spread either randomly or in rows.
- When you run your finger over nails, they are not smooth in texture
- A more severe case has a thimble-like texture.
- Pitting may involve a single nail, a limited number of nails, or all ten fingers (or toes) may be involved.
Possibly also in nail psoriasis, yellow-orange discoloration (also known as the so-called oil drop or salmon patch sign), chalky white spots, thickening of the nail, and nail detachment (lifting out of the nail bed) may occur. These other clinical manifestations can be used to diagnose psoriasis.
How Is Nail Pitting Diagnosed?
When you observe pitting of the nails, a visit to the doctor is always good. The diagnostic process is normally embraced to involve:[10]
- Examination of nails
- An elaborate medical history, such as skin problems, pains around the joints, or loss of hair.
- Family history questions were to be asked, as psoriasis and alopecia areata are hereditary.
- In other instances, a skin biopsy which involves a small piece of skin or nail under a microscope.
- Nail scrapings are also used to rule out the possibility of fungal infections, which may be similar to pitting.
Among the main points that should be drawn to the attention of clinicians, nail psoriasis and fungal nail infection (onychomycosis) are often mixed. Psoriasis is likely to lead to pitting and separation of nails free of smell, but fungus is likely to produce thick debris and a bad smell. Nail scrapings and lab tests can help ascertain which condition is in existence.
Nail Pitting Treatment
Treating nail pitting may not be very easy, mostly owing to the fact that the pits develop as the nail grows. Topical medications have limited penetration through the nail plate and are often more effective when applied to the proximal nail fold or used under occlusion.[11]
Effective Treatments
- Topical medication incorporates corticosteroid ointments or creams, derivatives of vitamin D such as calcipotriol, and retinoid creams. Such treatments are useful in mild to moderate cases.
- Injections – The medication is much nearer to the nail matrix with injections directly into the nail bed and are therefore more effective than topical applications in most patients.
- Systemic medications – The moderate to severe cases are treated using systemic medications, particularly in cases of psoriasis or psoriatic arthritis. These include:
- Light therapy (phototherapy) involves the use of light of a certain wavelength on the nails being worked on to stimulate the growth of healthy nails. Although its effectiveness for isolated nail disease is limited due to poor light penetration through the nail plate.
- Nutritional support – If it seems that your pitting is due to nutritional deficiency, then some supplements are beneficial, e.g, biotin, iron, zinc, or collagen peptide for nail recovery. Biotin may improve brittle nails in some individuals, but evidence is limited, and it does not treat autoimmune nail matrix inflammation.
A notable point to patients: Nails do not grow fast; fingernails grow about 3mm a month. This implies that you might not realize a positive change in three to six months, irrespective of the type of treatment you are applying. Patience is essential.
When Should You See a Doctor?
It is not that every tiny scratch in your nail has to bring you to the clinic immediately. You must make an appointment, however, in case:
- The pitting is new, worsening, or spreading to multiple nails
- Other symptoms that you have include pain in the joints, skin rashes, loss of hair, or a change in the color of your nails.
- You have a known condition like psoriasis and notice new nail changes
- The nails are separating from the nail bed or crumbling
Early diagnosis matters. Psoriasis or psoriatic arthritis, in some instances, is initially revealed by nail pitting, and this implies that your nails may warn you of a disease that requires medication long before other problems manifest.
Living with Nail Pitting
Pitting of nails is a condition that cannot be treated at home when it starts. Nonetheless, you can do something to make your nails healthy and less damaged:
- Have short nails so that they cannot get caught or torn.
- Moisturize your nails and cuticles regularly.
- Use gloves when washing the dishes or handling some hard chemicals.
- Do not use fake or acrylic nails, since this is likely to do more harm to a weak nail.
- In the presence of psoriasis, stress management may allow you to prevent the cases of flare-ups that aggravate pitting.
- You may buff your nails using a little nail polish to fix the nails aesthetically. This does not cure the problem, but it may help with self-belief.
Final Thoughts
Nail pitting could appear to be an inconvenience, a petty cosmetic issue, but it is worth paying some attention to. Your little dents in your nails are the flags of your body that it is waving to you, saying that something might be going on down there.l
It may be associated with nail pitting psoriasis, which is an autoimmune disease, or a nutritional deficiency. The positive thing is that nail pitting is treatable. Many individuals see actual improvement with the correct diagnosis and the correct strategy on the part of a doctor. So when you have been feeling these little dips on your nails and brushing them off, well, now is the time to pay attention to them. And when something does not look right, do not disregard it. Book that appointment. Ask the questions. Get the answers that your body has been struggling to offer you. Since occasionally the slightest symptoms give the most valuable findings regarding your health.
References
[1] Jiaravuthisan MM, Sasseville D, Vender RB, Murphy F, Muhn CY. Psoriasis of the nail: a review of the literature with a focus on therapy.Journal of the American Academy of Dermatology. 2007;57(1):1–27.
[2] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D.Rook’s Textbook of Dermatology. 9th ed. Wiley-Blackwell; 2016.(Standard reference for psoriatic nail disease pathophysiology)
[3] Tosti A, Morelli R, Bardazzi F, Peluso AM. Prevalence of nail abnormalities in children with alopecia areata.Pediatric Dermatology. 1994;11(2):112–115.
[4] Baran R, Dawber RPR, de Berker DAR, Haneke E, Tosti A.Baran and Dawber’s Diseases of the Nails and Their Management. 3rd ed. Blackwell Science; 2001.
[5] Tosti A, Peluso AM, Fanti PA, Morelli R. Nail lichen planus: clinical and pathologic study of twenty-four patients.Journal of the American Academy of Dermatology. 1993;28(5 Pt 1):724–730.
[6] Toivanen A, Toivanen P. Reactive arthritis: clinical features and treatment.Current Opinion in Rheumatology. 2000;12(4):300–305.
[7] Cashman MW, Sloan SB. Nutrition and nail disease.Clinics in Dermatology. 2010;28(4):420–425.
[8] Holzberg M. The nail in systemic disease. In: Baran R, Maibach HI, eds.Textbook of Cosmetic Dermatology. 4th ed. Informa Healthcare; 2010.
[9] Iorizzo M, Pazzaglia M, Piraccini BM, Tullo S, Tosti A. Brittle nails.Journal of Cosmetic Dermatology. 2004;3(3):138–144
[10] Grover C, Reddy BS, Uma Chaturvedi K. Diagnosis of nail psoriasis: importance of biopsy and histopathology.British Journal of Dermatology. 2005;153(6):1153–1158.
[11] Crowley JJ, Weinberg JM, Wu JJ, Robertson AD, Van Voorhees AS; National Psoriasis Foundation. Treatment of nail psoriasis: best practice recommendations from the Medical Board of the National Psoriasis Foundation.JAMA Dermatology. 2015;151(1):87–94.