From the Guidelines
Pocket marks on fingernails, also known as nail pitting, are a symptom that requires prompt medical attention to rule out underlying conditions such as psoriasis, alopecia areata, eczema, or connective tissue disorders. The presence of these marks can indicate a disruption in the nail formation process, leading to small depressions or dents in the nail surface. According to the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1, onychomycosis is a fungal disease of the nails that can be caused by various factors, including dermatophytes, molds, and Candida species. However, nail pitting is not typically associated with onychomycosis. Some key points to consider when evaluating pocket marks on fingernails include:
- The pattern, depth, and distribution of the pits can help determine the underlying cause
- Treatment focuses on addressing the underlying condition rather than the nail changes themselves
- Topical treatments like corticosteroids or vitamin D analogs may help for psoriasis-related pitting
- Systemic medications like methotrexate or biologics might be necessary for severe cases It's essential to consult a dermatologist for proper diagnosis and treatment, as nail pitting can be a symptom of an underlying condition that requires management to prevent progression and manage symptoms effectively 1.
From the Research
Pocket Marks on Fingernails
- Pocket marks on fingernails are not explicitly mentioned in the provided studies, however, some studies discuss nail disorders and their characteristics.
- Nail conditions such as brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis, and retronychia are common nail disorders seen in clinical practice 2.
- These conditions can present with nail plate changes, discoloration, pain, and inflammation, but pocket marks are not specifically mentioned as a characteristic of these conditions.
- The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units, and dermoscopy, diagnostic imaging, and histopathologic and mycological analyses may be necessary for diagnosis 2.
- Nail disease management requires a targeted treatment approach, including topical and/or systemic medications, discontinuation of offending drugs, or surgical intervention, depending on the condition 2.
- Nutritional deficiencies can also affect nail health, and biotin supplementation has been shown to improve brittle nail syndrome 3, 4.
- Changes in nail color, such as leukonychia, can provide important clues to underlying systemic and skin disease 5.
- Trauma, infections, and severe medical illnesses can produce nail dystrophies such as Beau lines, onychomadesis, and retronychia 6.