What do ridges in nails indicate?

Ridges in Fingernails: Causes and Clinical Significance

Vertical ridges on fingernails are most commonly a normal part of the aging process, but can also indicate underlying conditions such as lichen planus, psoriasis, nutritional deficiencies, or systemic diseases. 1

Common Causes of Nail Ridges

Vertical Ridges

• Age-related changes: The most common cause of vertical ridges is aging, as the nail matrix's ability to produce a smooth nail plate diminishes with time 1
• Inflammatory skin conditions:
  • Lichen planus can cause thinning of the nail plate and longitudinal ridging 1
  • Psoriasis can lead to nail ridging along with other nail manifestations 1
  • Darier disease, a rare genetic disorder, may present with nail dystrophy including ridging 1
• Rheumatoid arthritis: Longitudinal ridging on nine or ten fingernails has been significantly associated with rheumatoid arthritis 2
• Trauma and environmental factors:
  • Repetitive trauma to the nail plate can result in ridging and abnormal nail appearance 1
  • Excessive moisture exposure, particularly in occupations requiring frequent hand washing, can contribute to nail changes 1
• Nutritional factors:
  • Nutritional deficiencies can affect nail growth and appearance, potentially leading to brittleness and ridging 3
  • Deficiencies in biotin, other B vitamins, and minerals like iron, zinc, and magnesium may contribute to nail abnormalities 4

Onychorrhexis

• Characterized by longitudinal ridging with splitting or brittleness of the nail plate 5
• May be associated with systemic conditions or medication side effects 5
• Can result from nail matrix damage due to medications, trauma, or systemic disease 5

Differential Diagnosis

• Fungal nail infections (onychomycosis):

  • Present with thickening, discoloration, and friable nail texture 6
  • More commonly affect toenails than fingernails 6
  • Often accompanied by subungual hyperkeratosis and onycholysis 6

• Other conditions that may mimic ridged nails:

  • Bacterial infections (particularly Pseudomonas) causing green or black discoloration 6
  • Paronychia with secondary nail dystrophy 6
  • Koilonychia (spoon-shaped nails) which may be familial or associated with iron deficiency 7

Diagnostic Approach

• Examine all nails for pattern of involvement and look for associated skin conditions 1
• Assess for characteristic patterns that might distinguish between trauma, aging, and pathological causes 1
• If fungal infection is suspected, direct microscopic examination and culture may be necessary 6
• Consider underlying systemic conditions, especially when multiple nails are affected 8

Management

• For age-related vertical ridges:

  • Generally don't require treatment unless causing functional problems 1
  • Gentle nail care and moisturizing of cuticles and periungual tissues 1

• For underlying conditions:

  • Treat the primary cause when identified (e.g., inflammatory conditions like psoriasis or lichen planus) 1
  • For onychorrhexis, daily use of topical emollients on periungual folds and protective nail lacquers 5

• Preventive measures:

  • Avoid nail trauma, excessive water exposure, and harsh chemicals 5
  • Wear gloves while cleaning or working with chemicals 1
  • For brittle nails, oral supplementation with biotin, vitamins, trace elements, and amino acids may be beneficial 4

When to Seek Medical Attention

• Medical evaluation is recommended if ridges appear suddenly or change rapidly 1
• Seek care if ridges are associated with pain, inflammation, or nail separation 1
• Persistent nail changes without obvious cause warrant investigation for potential systemic conditions 8