What do ridged nails indicate about my health?

Vertical Ridges on Fingernails: Causes and Clinical Significance

Vertical ridges on fingernails are most commonly a normal sign of aging as the nail matrix's ability to produce a smooth nail plate diminishes with age. 1

Common Causes of Vertical Nail Ridges

• Age-related changes: Longitudinal striations running from cuticle to nail tip are often a normal part of the aging process as the nail matrix's ability to produce smooth nails decreases 1

• Inflammatory skin conditions:

  • Lichen planus can cause thinning of the nail plate and longitudinal ridging 1
  • Psoriasis can lead to nail ridging, often accompanied by other nail manifestations 1

• Genetic factors: Darier disease, a rare genetic disorder, can cause nail dystrophy including ridging 1

• Environmental factors:

  • Repetitive trauma can result in abnormal nail appearance including ridging 1
  • Excessive moisture exposure, particularly in occupations requiring frequent hand washing, can contribute to nail changes 1

• Onychorrhexis: Characterized by longitudinal ridging and splitting or brittleness of the nail plate, often presenting as part of nail matrix abnormalities 2

Potential Systemic Associations

• Thyroid disorders: Both hypothyroidism and hyperthyroidism can be associated with nail changes, though ridging specifically is not the primary nail manifestation 3

• Systemic diseases: Nail abnormalities can provide clues to underlying systemic conditions, though vertical ridging alone is less specific than other nail changes 4

• Nutritional deficiencies: Certain nutritional imbalances may contribute to nail changes, though they typically present with multiple nail abnormalities 5

When to Seek Medical Evaluation

Medical evaluation is recommended if:

• Ridges appear suddenly or change rapidly
• Ridges are associated with pain, inflammation, or nail separation
• There are other concerning nail changes such as discoloration or thickening 1

Management Approaches

• Address underlying causes when identified:

  • Manage inflammatory conditions like psoriasis or lichen planus
  • Avoid trauma-related factors
  • Use antifungal therapy if fungal infection is present 1

• Preventive nail care:

  • Apply daily topical emollients on periungual folds, matrix and nail plate
  • Use protective nail lacquers to limit water loss
  • Wear gloves while cleaning or working with chemicals
  • Avoid excessive moisture exposure 1, 2

Special Considerations

• In elderly patients, vertical ridges are often a normal finding and typically don't require treatment unless causing functional problems 1

• Nail changes can significantly impair performance of daily activities and reduce quality of life if left untreated 6

• Examination of the nails should be part of every medical visit as it may uncover important findings related to underlying health conditions 6