Have you ever noticed little depressions in your fingernails or toenails? This is called nail pitting. It can happen for a number of reasons and is often related to nail psoriasis. You may also have discoloration of your nails or abnormal growth with this condition. Here’s more about nail pitting, what causes it, and what treatments are available.
Nail pitting may show up as shallow or deep holes in your nails. The pitting can happen on your fingernails or your toenails. You may think the pitting looks like white spots or other marks. It might even look like your nails have been hit with an ice pick.
If your nail pitting is related to nail psoriasis, as it most often is, you may also experience:
- changes to the normal shape (deformation)
- changes in nail color (discoloration)
People with nail psoriasis may also experience loose nails that separate from their nail beds. The more technical term for this symptom is onycholysis. In the most severe cases, nail psoriasis can cause your nails to crumble.
You may experience nail psoriasis with or without other psoriasis symptoms.
- red, scaly patches of skin
- dry, cracked, or bleeding skin
- itching or burning skin
- stiff or swollen joints
Researchers have recently uncovered that there may be a link between nail pitting and the severity of psoriasis in general. In one 2013 study, 34.2 percent of people who had mild psoriasis also experienced nail pitting. In people who had severe, longer lasting cases of psoriasis, nail pitting was found 47.6 percent of the time.
There are a few other causes of nail pitting that are not related to psoriasis. They include:
- connective tissue disorders, such as Reiter’s syndrome (a form of reactive arthritis), and osteoarthritis
- autoimmune diseases, such as alopecia areata, sarcoidosis, and pemphigus vulgaris
- incontinentia pigmenti, a genetic disorder affecting the hair, skin, nails, teeth, and central nervous system
- atopic and contact dermatitis
If you notice pitting in your nails, it’s a good idea to visit your doctor.
At your appointment, your doctor will assess your medical history and perform a physical exam. Be sure to share any symptoms you may be experiencing with your doctor, as this can help guide them to a diagnosis of nail psoriasis or another condition.
They may also perform a skin biopsy. This test is done by taking a small sample of your skin or nails and looking at it under a microscope. Your doctor will likely take the sample after applying a local anesthetic, so this procedure shouldn’t hurt.
Treating nail pitting can be difficult. The pits are formed as your nail forms. Topical medications are unable to easily reach through the nail bed. Because of this, your doctor may consider corticosteroid injections into your nail beds. This type of treatment has varied results.
Another option is to use phototherapy or light therapy on the affected nails. Some doctors may recommend taking vitamin D3 supplements.
Immunosuppressant medications, such as cyclosporine (Neoral) and methotrexate (Trexall), are also options. However, they typically aren’t recommended if you only have nail pitting. These medications are potentially toxic to your organs, so the risks may outweigh the benefits.
Treating nail pitting is often a long-term process that doesn’t always have the best results. You may want to cosmetically repair already pitted nails by scraping, filing, or polishing.
In rare cases, you may opt to have them removed through surgery so that the nail tissue can regrow.
Treatment of nail pitting and other nail issues is often a long-term process. In some cases, this treatment isn’t always effective. It’s important that you try to avoid triggers that make nail pitting worse. This includes trauma to your hands and feet.
If you’re diagnosed with nail psoriasis, the outlook varies. Psoriasis is a chronic condition that tends to flare up at different times of your life for different reasons.
People who have nail psoriasis often deal with physical and psychological stress and negative feelings about their condition. If you’re feeling stressed or upset about your diagnosis, discuss these feelings with your doctor. They can provide guidance and other resources for support.
You should also contact your doctor if you notice thickening of a nail or separation from the nail bed. This may mean you have a fungal infection that needs treatment.
You may not be able to prevent pitting in your nails, but you can reduce your risk for worsened symptoms.
You can help keep your nails healthy by:
There are also certain things that you can do to avoid triggers:
Tips and tricks
- Clip your nails as short as you can. If your nails are loose, they may rub off or get more damaged.
- Wear gloves if you are doing work with your hands. Use thin cotton gloves underneath vinyl or nitrile gloves when you’re cooking or washing dishes. Steer clear of latex gloves.
- Skip manicures. They may cause trauma to your nails and trigger more pitting.
- Use a moisturizer or cream on your hands, feet, and in your nail folds to keep your skin hydrated and protected.
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