What causes vertical lines on fingernails?

Causes of Vertical Lines on Fingernails

Vertical lines (longitudinal ridging) on fingernails are most commonly a normal age-related change, but can also indicate underlying medical conditions including trauma, systemic diseases, or nutritional deficiencies.

Common Causes of Vertical Nail Ridges

Age-Related Changes

• Vertical ridges are often a normal part of aging as the nail matrix's ability to produce a smooth nail plate diminishes with time 1
• These age-related changes typically appear as longitudinal striations that run from the cuticle to the tip of the nail

Trauma and Injury

• Physical trauma to the nail matrix can result in vertical ridging 2
• Repeated trauma or pressure on the nail bed can cause permanent changes to nail growth patterns 3

Systemic Diseases

• Vertical nail ridges may be associated with various systemic conditions:
  • Peripheral vascular disease 1
  • Connective tissue disorders 1
  • Raynaud's phenomenon 1
  • Inflammatory bowel disease 1

Nutritional Factors

• Nutritional deficiencies can contribute to nail brittleness and vertical ridging:
  • Iron deficiency anemia may present with koilonychia ("spoon nails") and vertical ridging 1, 4
  • Deficiencies in biotin, amino acids, and other micronutrients can affect nail plate formation 4

Medication-Related Causes

• Certain medications can affect nail growth and appearance:
  • Cytotoxic drugs (taxanes, anthracyclines, EGFR inhibitors) 5
  • Anti-infective drugs (tetracyclines, quinolones) 5
  • Retinoids 5

Distinguishing Features from Other Nail Conditions

Vertical vs. Horizontal Lines

• Vertical lines run from cuticle to tip and generally indicate slower, chronic processes 3
• Horizontal lines (Beau's lines) suggest temporary arrest of nail growth due to acute illness or injury 2

When to Seek Medical Evaluation

• Sudden appearance of vertical lines in all nails
• Vertical lines accompanied by pain, inflammation, or nail separation
• Vertical ridging with discoloration or thickening of nails
• Presence of other systemic symptoms 3

Management Approaches

General Nail Care

• Moisturize nails and cuticles regularly to prevent excessive dryness 4
• Avoid trauma and excessive exposure to water or chemicals 4
• Use protective gloves for wet work or exposure to irritants 4

Nutritional Support

• Supplementation with biotin (2.5 mg daily) may improve nail strength in brittle nails with vertical ridging 4
• Ensure adequate intake of protein, iron, zinc, and essential fatty acids 4

Treatment of Underlying Conditions

• Addressing any underlying systemic disease is essential for improving nail appearance 1, 3
• If medication-related, discuss with healthcare provider about possible alternatives 5

Important Considerations

• Isolated vertical ridging without other symptoms is rarely a cause for concern
• Persistent changes in nail appearance should be evaluated to rule out systemic disease 1
• Vertical lines that appear suddenly or are associated with pain warrant prompt medical attention 3