From the Guidelines
Nail pitting is most commonly caused by psoriasis, as evidenced by a case study of a 55-year-old man with psoriasis who presented with nail pitting and onycholysis 1. The causes of nail pitting can be attributed to various conditions, including:
- Psoriasis: a chronic skin condition characterized by inflammation and keratinization defects, leading to nail pitting and other nail abnormalities 1
- Alopecia areata: an autoimmune condition that can cause nail pitting, among other symptoms
- Eczema: a skin condition that can lead to nail pitting and other nail changes Nail pitting occurs when cells in the nail matrix are affected by inflammation, resulting in defective keratinization and the formation of small depressions or holes in the nail surface. Treatment of nail pitting primarily focuses on managing the underlying condition, such as psoriasis, rather than the pits themselves. For psoriatic nail pits, topical treatments like potent corticosteroids, calcipotriol, or tazarotene gel may help, and should be applied to the nail fold and nail plate for several months 1. It is essential to consult a dermatologist for proper diagnosis and treatment of nail pitting, as existing pits will remain until the nail grows out completely, which can take several months to a year or more, depending on the nail's growth rate.
From the Research
Causes of Nail Pitting
The causes of nail pitting, also known as nail pits, can be attributed to various factors, including:
- Alopecia areata (AA), an autoimmune disease that can cause hair loss and nail changes, including pitting 2, 3, 4
- Psoriasis, a chronic skin condition that can cause nail changes, including pitting 5, 6
- Other systemic diseases or infections that can affect the nails 5
- Inflammatory or traumatic conditions that can cause nail changes 5
Associated Conditions
Nail pitting can be associated with other nail changes, such as:
- Trachyonychia, a condition characterized by rough, brittle nails 2, 3, 4
- Leukonychia, a condition characterized by white spots or streaks on the nails 2
- Red lunula, a condition characterized by red spots on the lunula (the half-moon shaped area at the base of the nail) 2, 4
- Longitudinal ridging, a condition characterized by ridges or grooves on the nails 2
- Brittle nails, a condition characterized by weak, fragile nails 2, 5
Prevalence and Impact
Nail pitting can be a common finding in patients with alopecia areata, with a prevalence of up to 64.1% 4. While nail changes can be asymptomatic, they can also be cosmetically disfiguring and affect quality of life 2, 5.