What Is Nail Pitting and How to Treat It?

The eyes may be the windows to the soul, but the nails are the windows to your internal organs. Nail changes are often an excellent way to help diagnose certain internal medical conditions. Nail pitting is a nail condition caused by several medical problems, and it usually affects one or more nails. Read on to learn what causes nail pitting, what it looks like, and how to diagnose and treat it.

What is nail pitting?

Nail pits are small deep or shallow dents that appear on the nails. They more commonly appear on the fingernails than the toenails.

Patients can present with one or many pits on the nails. These pits usually occur as a result of inflammation in the nail matrix, which is the area from which the nail grows. This inflammation is the result of an underlying medical condition.

The appearance of nail pits correlates with the increasing severity of the underlying condition. Other issues with the nails may appear as well, such as separation, discoloration, or loss of the nail.

Causes of nail pitting

There are various underlying conditions that can cause nail pitting. In most cases, nail pits present along with other findings. If you discover nail pits, see your doctor to determine the cause.

These are the most common causes of nail pits:

• Psoriasis. The exact cause of psoriasis is unknown; however, it results from a problem with the immune system. There may also be a genetic component. It leads to inflammation in the skin, joints, and nails.
• Eczema or atopic dermatitis. This condition arises from an overactive immune system. It also has a genetic component since it runs in families. It causes inflammation in the skin and nails.
• Autoimmune. Autoimmune conditions, like alopecia areata, occur when the body attacks its own hair follicles and causes hair loss. This inflammation that causes hair loss can also affect the nails.
• Reactive arthritis. Reactive arthritis is a genetic condition triggered by an infection that leads to inflammation in the skin, joints, eyes, genitourinary system, and nails.
• Sarcoidosis. This genetic condition may be triggered by an infection and lead to inflammation in the skin, lungs, and other organs.
• Lichen planus. This rare condition arises from an abnormally functioning immune system that leads to inflammation in the skin, mucosa, hair, and nails and ultimately the destruction of the hair and nails. Lichen planus may be triggered by infections like hepatitis C, medications, stress, or certain foods.
• Incontinentia pigmenti. This is a rare genetic condition that causes inflammation in the skin, nails, and other organs.
• Contact dermatitis. This inflammatory rash is caused by irritation from or an allergic reaction to certain substances that appear on the skin. If the hands are involved, nail pitting may occur.
• Leprosy. This is a bacterial infection that causes skin lesions, nerve damage, hair loss, and nail problems like pitting.

Diagnosis of nail pitting

A consultation with a doctor is necessary to properly diagnose nail pitting and determine the cause. The doctor will ask about your medications, supplements, and medical history. A physical exam is essential to help determine the cause of nail pitting. The doctor may also want to order laboratory tests or perform a skin or nail biopsy.

Treatment for nail pitting

Nail pitting is often difficult to treat, and the treatments available are not always effective. The treatment also depends on the cause of the nail pitting.

Topical steroid creams and ointments rarely work on nail pitting. Steroid injections, surgery, and systemic immune suppressant medications may help in cases of psoriasis, eczema, contact dermatitis, alopecia areata, sarcoidosis, reactive arthritis, and lichen planus.

If you have mild nail pitting, it may not be worth the risk of these treatments. Because leprosy is an infection, it is treated with oral antibiotics, which may improve nail pitting. Also, some cases of reactive arthritis respond to oral antibiotics, which may in turn improve nail pitting. There is no specific treatment for nail pitting associated with incontinentia pigmenti.

What happens if nail pitting is not treated?

Without treatment, nail pitting could worsen and lead to disfigurement of the nail, difficulty moving the affected fingers or toes, and discomfort.

If nail pitting does not cause any discomfort or disability, it does not need to be treated. It may improve after successful treatment of the underlying condition, such as psoriasis. If it does not improve, you can treat it for cosmetic reasons.

How do I manage nail pitting?

If you have chosen not to treat your nail pitting or have failed previous treatments, you may have to learn to live with it. There are some things you can do to lessen future problems:

• Be sure to keep your nails short so they do not get torn.
• Always use gloves when washing dishes or gardening to protect your nails from additional damage.
• Avoid manicures and pedicures which may harm your nails.
• Mild soap and gentle moisturizers are essential.
• Harsh chemicals can damage the nails and further complicate your situation.
• Moisturize the skin on your hands and nails several times a day to keep them hydrated and protected.

Nail pitting is a rare medical condition. It may appear in conjunction with several different medical conditions, most commonly psoriasis. Because many different medical conditions can present with nail pitting, proper diagnosis of the cause of your nail pitting is crucial. If you notice nail pitting, you must see your doctor immediately for the correct diagnosis and proper treatment.