What Causes Pitted Fingernails?

Pitted fingernails look like small dents in the nails, as if an icepick had hit them. Nail pitting can also affect the toenails and cause crumbling of the nails or loose nails that separate from the skin. One of the most common causes of nail pitting is psoriasis. This chronic skin condition causes red and silver itchy, scaly skin.

Other causes of nail pitting include atopic dermatitis (eczema) and alopecia areata (hair loss). If you have nail pitting, it's important to see a healthcare provider. They can administer tests that rule out and diagnose underlying conditions. These conditions are chronic, meaning that nail pitting can be long-lasting. However, treatments that help address the root cause can preserve your nails.

As many as 50% of people with psoriasis have nail changes, including pitted fingernails. Read on to learn more about nail pitting, including causes, treatments, and more.

What Does Nail Pitting Look Like?

Nail pitting can affect the fingernails and toenails. You might notice the following characteristics:

• Crumbling of the nail
• Deep or shallow depressions in the nails
• Loose nails that can fall off

Causes of Pitted Fingernails

These small dents in your nails might be a sign of an underlying health condition. Some of the most common causes of nail pitting include psoriasis, atopic dermatitis, and alopecia areata. Other, more rare diseases can also cause pitted fingernails.

1. Psoriasis

Nail changes might not be the first symptom that comes to mind when you think of psoriasis, but it's not uncommon. Psoriasis can also make nails thicken or, in a process called onycholysis, cause them to separate from the underlying nail beds.

These nail changes are most common in people with psoriatic arthritis (PsA). PsA most commonly causes joint pain, stiffness, and swelling in people with psoriasis.

It's essential to check your fingernails and toenails for signs that the condition spreads to your nails if you have psoriasis. Common symptoms of nail psoriasis include:

• Bleeding
• Crumbling nails
• Plaque buildup under your nail
• Separated nails
• Tiny dents in your nails, or "nail pits"
• White, yellow, or brown nails

2. Alopecia Areata

Alopecia areata causes hair loss, which mostly occurs on the scalp but can affect any body part. Nail changes, including pitted fingernails, are a common sign of alopecia areata. Research has shown that about 20% of people with this condition have nail pitting.

3. Arthritis

In addition to PsA, nail pitting is a common sign of reactive arthritis. This type of arthritis develops as a result of a bacterial infection and can cause inflammation of the eyes, genitals, skin, and urinary tract.

Symptoms include abdominal pain, conjunctivitis (pink eye), diarrhea, and joint pain or stiffness. Nail changes, such as pitted fingernails and onycholysis (nail separation), may also occur.

4. Dermatitis

Dermatitis is an itchy, red, and sometimes painful skin rash. Allergens or irritants may cause a skin rash, or contact dermatitis. Nail pitting can occur with atopic dermatitis, commonly called eczema. This is a long-term disease that also causes symptoms like blisters, dry skin, and skin redness or inflammation.

Nail pitting can affect people who have eczema on their hands and feet. Research has shown that eczema can cause changes in the nail matrix region, leading to pits.

5. Lichen Planus

Lichen planus causes an itchy rash around or on the inside of the mouth. Hepatitis C, certain drugs, and some metals or chemicals can result in lichen planus, but the exact cause isn't clear. Symptoms include ridges in the nails, dry mouth, hair loss, and metallic taste.

6. Incontinentia Pigmenti

Incontinentia pigmenti is a rare genetic disorder that affects the eyes, hair, nervous system, teeth, or skin. Nail pitting is a common symptom, affecting 7% to 40% of people with the condition. Pits usually affect all the fingernails and toenails but can go away with age.

7. Sarcoidosis

Sarcoidosis is an autoimmune disorder that affects the lungs and lymph nodes, causing inflammatory cells to form lesions. Although rare, nail pitting may affect people with this condition. Some evidence suggests that nail changes affect as many as three in 188 of people with sarcoidosis. These changes include pitting, cracking, onycholysis, and thickening.

When To See a Healthcare Provider

If you notice nail pitting, it's important to see a dermatologist (who specializes in the skin, nails, and hair). A dermatologist can examine your nails and perform tests to rule out health conditions and confirm a diagnosis.

In addition to nail pitting, see a dermatologist if you have nails that:

• Are blue, clubbed, distorted, pale, peeling, painful, or ingrown
• Have horizontal ridges
• Have white lines or white color underneath

Pitted Fingernails Treatment

Don't ignore nail pitting. Pitted nails may worsen, or an infection can develop without treatment if you have nail psoriasis. Some people might even develop "disappearing" nails, affecting their ability to use their hands or walk. Treatment can be challenging, but a healthcare provider can recommend the proper therapies to clear painful symptoms.

If you have mild or early nail psoriasis, a healthcare provider might prescribe medicine, such as calcipotriol, corticosteroids, or tazarotene. You'll apply the medicine to your nails for several months, often once or twice daily. A healthcare provider may sometimes combine two medications to increase the treatment's efficacy.

These medicines aren't highly effective on their own. A healthcare provider may recommend treatment in their office or clinic, such as:

• Corticosteroids injections
• Laser treatment
• Phototherapy, which uses light to treat psoriasis symptoms
• Other medicines, such as apremilast, biologics, cyclosporines, deucravacitinib, methotrexate, retinoids, and upadacitinib

It's also important to avoid physical stress on your nails. Try avoiding putting too much pressure on your fingers or toes if psoriasis affects your nails. You might open a door with your whole body, for example, rather than the tips of your fingers.

Prevention

You may not always be able to prevent pitted fingernails. There are still some ways you can reduce your risk of nail changes:

• Avoid biting, picking, or tearing your nails
• Clip hangnails
• Keep your nails short and limit how often you use nail polish
• Make sure your shoes fit properly, and they do not squeeze your toes tightly together
• Provide your own manicure tools at a nail salon and ask the manicurist not to remove your cuticles
• Talk to a healthcare provider or pharmacist about taking biotin supplements to support nail growth
• Trim your toenails in a straight line
• Use lotion on your hands after bathing or showering

A Quick Review

Pitted fingernails look like small dents in the nails and can be a sign of an underlying health condition. For example, nail changes are a fairly common symptom in people with psoriasis. Other causes include arthritis, atopic dermatitis, and alopecia areata.

Treatment can be challenging, but it's essential to alleviating painful symptoms and preventing further complications. Your healthcare provider may treat pitted nails with corticosteroid injections, laser treatment, phototherapy, and other medicines. You can try to preserve your nails by avoiding biting them, keeping them trimmed short, and limiting how often you use nail polish.