How to identify and treat nail pits

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What Exactly Are Nail Dimples?

Have you ever noticed little indentations on your fingernails or toenails? This is called nail depression. It can occur for a variety of reasons and is often associated with nail psoriasis. In this case, your nails may also become discolored or grow abnormally. Here’s more about sunken nails, what causes it, and the treatments available.

Nail depressions: uneven nails caused by horizontal lines

How to identify nail pits

Nail pits may appear as shallow or deep holes in the nail. Pitting can occur on your fingernails or toenails. You might think pitting looks like white spots or other markings. It may even look like your nail was hit with an ice pick.

If your nail pits are related to nail psoriasis, typically, you may also experience:

Change to normal shape (deformation)
Thickening
Nail color change (discoloration)

People with nail psoriasis may also experience loose nails that separate from the nail bed. The more technical term for this symptom is onycholysis. In the most severe cases, nail psoriasis can cause your nails to chip.

You may experience nail psoriasis with or without other psoriasis symptoms.

These include:

red scaly skin patches
Dry, cracked, or bleeding skin
itching or burning of the skin
joint stiffness or swelling

Causes of sunken nails

Up to 50% of people with psoriasis will have changes in their nails. 5 to 10 percent of people with nail psoriasis do not experience any other symptoms.

Nail pitting is relatively common; commonly seen in people with psoriatic arthritis. It is also relatively common; generally among people over 40 years old.

Researchers recently discovered a possible link between nail pitting and the severity of psoriasis in general. In a 2013 study,Trusted Source 34.2% of people with mild psoriasis also experienced pitted nails. In people with severe, long-lasting cases of psoriasis, indented nails were found 47.6 percent of the time.

There are other causes of sunken nails that are not related to psoriasis. They include:

Connective tissue disorders such as Reiter syndrome (a type of reactive arthritis) and osteoarthritis
Autoimmune diseases such as alopecia areata, sarcoidosis, and pemphigus vulgaris
Incontinence pigmenti, a genetic disorder affecting the hair, skin, nails, teeth, and central nervous system
Atopic and contact dermatitis

How is an indented nail diagnosed?

If you notice dents on your nails, it's best to see your doctor.

At your appointment, your doctor will evaluate your medical history and perform a physical examination. Be sure to share any symptoms you may be experiencing with your doctor, as this can help guide them in diagnosing nail psoriasis or other conditions.

They may also perform a skin biopsy. This test is done by taking a small sample of skin or nails and looking at it under a microscope. Your doctor may take the sample after applying a local anesthetic, so the procedure shouldn't hurt.

Treatment options for sunken nails

Treating an indented nail can be difficult. These pits form when your nails form. Topical medications cannot reach easily through the nail bed. Therefore, your doctor may consider injecting corticosteroids into your nail beds. This type of treatment has varying results.

Another option is to use phototherapy or phototherapy on the affected nail. Some doctors may recommend taking vitamin D3 supplements.

Immunosuppressant drugs, such as cyclosporine (Neoral) and methotrexate (Trexall), are also optional. However, they are generally not recommended if you only have indented nails. These drugs can be toxic to your organs, so the risks may outweigh the benefits.

Treating nail pits is usually a long-term process and doesn't always have the best results. You may want to repair a nail that has become pitted by scraping, filing, or polishing it.

In rare cases, you may choose to have them surgically removed so that the nail tissue can regenerate.

Is there any way to treat sunken nails?

Treatment for nail pits and other nail problems is usually a long-term process. In some cases, this treatment is not always effective. It is important that you try to avoid triggers that make pitted nails worse. This includes trauma to your hands and feet.

If you've been diagnosed with nail psoriasis, the outlook is different. Psoriasis is a chronic disease that tends to break out at different times in your life for different reasons.

People with nail psoriasis often face physical and psychological stress and negative emotions about their condition. If you feel stressed or upset about your diagnosis, discuss these feelings with your doctor. They can provide guidance and other support resources.

You should also contact your doctor if you notice that your nails are thickening or separating from the nail bed. This may mean you have a fungal infection that needs treatment.