Table of ContentsView AllTable of ContentsNail PittingBeau’s LinesSpoon NailsWhen to See a Healthcare ProviderSummary
Table of ContentsView All
View All
Table of Contents
Nail Pitting
Beau’s Lines
Spoon Nails
When to See a Healthcare Provider
Summary
Denting in the fingernails refers to lines,ridges, or holes in thefingernails or toenails. These dents in the nails can be shallow or deep and found on various parts of the nail in different directions. There are many causes of nail denting including dermatologic conditions andautoimmune diseasesthat cause skin cell overgrowth and buildup.
Dents in fingernails have different causes including nail pitting, Beau’s lines, and spoon nails. Read on to learn more about their signs, causes, and treatments.
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Dents, ridges, and holes in the nails can occur due to an issue with how the layers in the superficial nail plate develop.This is called nail pitting. The superficial nail plate is the hard part of the nail that is made up of a type of protein known askeratin, which also comprises your hair and skin. The superficial nail plate protects the skin underneath.
One condition often associated with nail pitting isnail psoriasis. Roughly 50% of people with psoriasis also have symptoms that affect their nails.Nail psoriasis is more likely to affect your fingernails than your toenails.
Some research has found thatpeople over the age of 40have nail pitting twice as often as those under 20 years old.
Signs
Other symptoms may include:
How Is the Cause of Nail Pitting Diagnosed?Your doctor will assess your symptoms as well as take your health history to determine the possible causes of your nail pitting. Even symptoms that you are unsure of may be connected, so it’s important to share all the symptoms you are experiencing along with the ones that are affecting your nails. In some cases, a skin biopsy may be taken to identify any infections or cell abnormalities.
How Is the Cause of Nail Pitting Diagnosed?
Your doctor will assess your symptoms as well as take your health history to determine the possible causes of your nail pitting. Even symptoms that you are unsure of may be connected, so it’s important to share all the symptoms you are experiencing along with the ones that are affecting your nails. In some cases, a skin biopsy may be taken to identify any infections or cell abnormalities.
Causes and Treatments
Although nail pitting can occur in people with psoriasis, research has shown that it is more common in people who havepsoriatic arthritis.Psoriatic arthritis typically causes joints to become swollen and inflamed, but it can also cause other symptoms including nail pitting.
There are many other health conditions that can cause nail pitting. Some of them are skin disorders, while others are not. The health disorders that can lead to the development of nailpittinginclude:
In mild cases of nail pitting, treatment may not be required. This is especially true if the nail pitting isn’t causing any discomfort. Medicinal creams are not always effective because they may not reach the nail bed. However, some cases of nail pitting may be treated with vitamin D3and a corticosteroid, a drug that can help reduce inflammation.
Medications that affect how the immune system functions, such as synthetic forms of vitamin D (vitamin D analogs) and calcineurin inhibitors, are also often used to help clear up the condition.
In more severe cases of nail psoriasis with nail pitting, biologics therapy is the first-line option.Biologics are medications made from tiny living components such as proteins, sugars, or DNA.
Overview of Nail Psoriasis
Treatment options for other disorders that can cause nail pitting include:
Eczema on Nails, What It Looks Like, and How It’s Diagnosed and Treated
Beau’s lines refers to an abnormality on the nail plate where indentations form. They were named for French physician Joseph Honoré Simon Beau who first discovered the condition.
Beau’s lines can appear as moat-like depressions or dents on one or more nails. They run horizontally across the nail plate and can affect all fingernails or just a few. They can also affect one or more toenails, most often on the big toe. Beau’s lines sometimes have a slight yellow discoloration similar to a fungal infection.
There’s no specific treatment for Beau’s lines. Certainly avoiding triggers of an existing skin disorder, such as stress, smoking, alcohol use, and obesity may keep them at bay.While you may not always be able to prevent Beau’s lines from happening, eating a diet rich invitaminsand nutrients and staying hydrated can keep the nails healthy and less at risk.That being said, once they form the best course of action is to treat the underlying cause. Keeping your nails short, healthy, and hydrated while addressing the cause will keep them from returning once the nail grows out.
Spoon nails, also known askoilonychia, is a condition where the nail takes on a concave or cup-like shape as it grows. This can affect anyone including infants for a myriad of reasons.
Spoon nails are considered to be a manifestation of something deeper in the body. Chronic iron deficiency is one of the main causes as well as other conditions that can lead to malnutrition such as celiac disease. Endocrine disorders, autoimmune conditions, and nutritional deficiencies are also often causes.
Treating spoon nails involves treating the underlying disease. Getting prompt treatment can prevent the condition from worsening over time. For example, replenishing iron levels can reverse the condition. It’s important to work with your healthcare provider to determine the cause and course of treatment. In the meantime, keeping your nails clean and moisturized will help promote growth.
What Is Psoriasis?
If your nail denting develops because of an underlying health condition, the severity will vary. In most cases, this isn’t serious and is just a source of cosmetic distress. Severe cases, however, can lead to discomfort and pain that can affect the way you walk and use your hands. Since the nails continue to grow at a slow pace, it can be difficult to determine the cause and control it.
The best thing course of action is to visit your doctor. They will help determine theunderlying causeand best course of treatment. In the meantime, try to keep your nails as moisturized as possible, wear protective gloves during certain activities, and avoid any things that may damage them further, such as manicures.
Nail abnormalities such as pitting, Beau’s lines, and spoon nails usually indicate an underlying issue. Skin disorders, nutritional deficiencies and vitamin deficiencies are some of the factors affecting nail health resulting in these dents appearing on the nail.
While no specific treatments are available once this occurs, seeking treatment for the cause can prevent these abnormalities from returning once the nail has grown out. Because our nails can act as a window to our overall health and this could signal a deeper concern within the body, consult with your healthcare provider to determine the cause and best course of action for treatment.
18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Singal A, Arora R.Nail as a window of systemic diseases.Indian Dermatol Online J.2015;6(2):67-74. doi:10.4103/2229-5178.153002Schons KR, Knob CF, Murussi N, Beber AA, Neumaier W, Monticielo OA.Nail psoriasis: a review of the literature.An Bras Dermatol.2014;89(2):312-317. doi:10.1590/abd1806-4841.20142633National Psoriasis Foundation.Hands, Feet and Nails.Singh SK.Finger nail pitting in psoriasis and its relation with different variables.Indian J Dermatol.2013 Jul;58(4):310-312. doi:10.4103/0019-5154.113955American Academy of Dermatology Association.What is nail psoriasis, and how can I treat it?Bentaleb I, Abdelghani KB, Rostom S, Amine B, Laatar A, Bahiri R.Reactive Arthritis: Update.Curr Clin Microbiol Rep.2020 Sep 26:1-9. doi:10.1007/s40588-020-00152-6Chung BY, Choi YW, Kim HO, Park CW.Nail Dystrophy in Patients with Atopic Dermatitis and Its Association with Disease Severity.Ann Dermatol.2019 Apr;31(2):121-126. doi:10.5021/ad.2019.31.2.121Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia.2017;55(3):131-135. doi:10.5114/reum.2017.68912Pasch MC.Nail Psoriasis: A Review of Treatment Options.Drugs.2016 Apr;76(6):675-705. doi:10.1007/s40265-016-0564-5Rigopoulos D, Stathopoulou A, Gregoriou S.Small Molecules and Biologics in the Treatment of Nail Psoriasis.Skin Appendage Disord.2020 Jun;6(3):134-141. doi:10.1159/000507298Johns Hopkins Medicine.Pemphigus Vulgaris.Noriega L, Criado P, Gabbi T, Avancini J, Di Chiacchio N.Nail Sarcoidosis with and without Systemic Involvement: Report of Two Cases.Skin Appendage Disord.2015 Sep;1(2):87-90. doi:10.1159/000435923Triyangkulsri K, Suchonwanit P.Role of janus kinase inhibitors in the treatment of alopecia areata.Drug Des Devel Ther. 2018;12:2323-2335. Published 2018 Jul 27. doi:10.2147/DDDT.S172638Iorizzo M, Tosti A, Starace M, Baran R, Daniel CR 3rd, Di Chiacchio N, Goettmann S, Grover C, Haneke E, Lipner SR, Rich P, Richert B, Rigopoulos D, Rubin AI, Zaiac M, Piraccini BM.Isolated nail lichen planus: An expert consensus on treatment of the classical form.J Am Acad Dermatol.2020 Dec;83(6):1717-1723. doi:10.1016/j.jaad.2020.02.056Frazier W, Bhardwaj N.Atopic Dermatitis: Diagnosis and Treatment.Am Fam Physician.2020 May 15;101(10):590-598.Alobaida S, Lam JM.Beau lines associated with COVID-19.CMAJ. 2020;192(36):E1040-E1040. doi:10.1503/cmaj.201619Haneke E.Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management.Psoriasis (Auckl).2017 Oct 16;7:51-63. doi:10.2147/PTT.S126281National Library of Medicine.Spoon Nails.
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Singal A, Arora R.Nail as a window of systemic diseases.Indian Dermatol Online J.2015;6(2):67-74. doi:10.4103/2229-5178.153002Schons KR, Knob CF, Murussi N, Beber AA, Neumaier W, Monticielo OA.Nail psoriasis: a review of the literature.An Bras Dermatol.2014;89(2):312-317. doi:10.1590/abd1806-4841.20142633National Psoriasis Foundation.Hands, Feet and Nails.Singh SK.Finger nail pitting in psoriasis and its relation with different variables.Indian J Dermatol.2013 Jul;58(4):310-312. doi:10.4103/0019-5154.113955American Academy of Dermatology Association.What is nail psoriasis, and how can I treat it?Bentaleb I, Abdelghani KB, Rostom S, Amine B, Laatar A, Bahiri R.Reactive Arthritis: Update.Curr Clin Microbiol Rep.2020 Sep 26:1-9. doi:10.1007/s40588-020-00152-6Chung BY, Choi YW, Kim HO, Park CW.Nail Dystrophy in Patients with Atopic Dermatitis and Its Association with Disease Severity.Ann Dermatol.2019 Apr;31(2):121-126. doi:10.5021/ad.2019.31.2.121Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia.2017;55(3):131-135. doi:10.5114/reum.2017.68912Pasch MC.Nail Psoriasis: A Review of Treatment Options.Drugs.2016 Apr;76(6):675-705. doi:10.1007/s40265-016-0564-5Rigopoulos D, Stathopoulou A, Gregoriou S.Small Molecules and Biologics in the Treatment of Nail Psoriasis.Skin Appendage Disord.2020 Jun;6(3):134-141. doi:10.1159/000507298Johns Hopkins Medicine.Pemphigus Vulgaris.Noriega L, Criado P, Gabbi T, Avancini J, Di Chiacchio N.Nail Sarcoidosis with and without Systemic Involvement: Report of Two Cases.Skin Appendage Disord.2015 Sep;1(2):87-90. doi:10.1159/000435923Triyangkulsri K, Suchonwanit P.Role of janus kinase inhibitors in the treatment of alopecia areata.Drug Des Devel Ther. 2018;12:2323-2335. Published 2018 Jul 27. doi:10.2147/DDDT.S172638Iorizzo M, Tosti A, Starace M, Baran R, Daniel CR 3rd, Di Chiacchio N, Goettmann S, Grover C, Haneke E, Lipner SR, Rich P, Richert B, Rigopoulos D, Rubin AI, Zaiac M, Piraccini BM.Isolated nail lichen planus: An expert consensus on treatment of the classical form.J Am Acad Dermatol.2020 Dec;83(6):1717-1723. doi:10.1016/j.jaad.2020.02.056Frazier W, Bhardwaj N.Atopic Dermatitis: Diagnosis and Treatment.Am Fam Physician.2020 May 15;101(10):590-598.Alobaida S, Lam JM.Beau lines associated with COVID-19.CMAJ. 2020;192(36):E1040-E1040. doi:10.1503/cmaj.201619Haneke E.Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management.Psoriasis (Auckl).2017 Oct 16;7:51-63. doi:10.2147/PTT.S126281National Library of Medicine.Spoon Nails.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Singal A, Arora R.Nail as a window of systemic diseases.Indian Dermatol Online J.2015;6(2):67-74. doi:10.4103/2229-5178.153002Schons KR, Knob CF, Murussi N, Beber AA, Neumaier W, Monticielo OA.Nail psoriasis: a review of the literature.An Bras Dermatol.2014;89(2):312-317. doi:10.1590/abd1806-4841.20142633National Psoriasis Foundation.Hands, Feet and Nails.Singh SK.Finger nail pitting in psoriasis and its relation with different variables.Indian J Dermatol.2013 Jul;58(4):310-312. doi:10.4103/0019-5154.113955American Academy of Dermatology Association.What is nail psoriasis, and how can I treat it?Bentaleb I, Abdelghani KB, Rostom S, Amine B, Laatar A, Bahiri R.Reactive Arthritis: Update.Curr Clin Microbiol Rep.2020 Sep 26:1-9. doi:10.1007/s40588-020-00152-6Chung BY, Choi YW, Kim HO, Park CW.Nail Dystrophy in Patients with Atopic Dermatitis and Its Association with Disease Severity.Ann Dermatol.2019 Apr;31(2):121-126. doi:10.5021/ad.2019.31.2.121Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia.2017;55(3):131-135. doi:10.5114/reum.2017.68912Pasch MC.Nail Psoriasis: A Review of Treatment Options.Drugs.2016 Apr;76(6):675-705. doi:10.1007/s40265-016-0564-5Rigopoulos D, Stathopoulou A, Gregoriou S.Small Molecules and Biologics in the Treatment of Nail Psoriasis.Skin Appendage Disord.2020 Jun;6(3):134-141. doi:10.1159/000507298Johns Hopkins Medicine.Pemphigus Vulgaris.Noriega L, Criado P, Gabbi T, Avancini J, Di Chiacchio N.Nail Sarcoidosis with and without Systemic Involvement: Report of Two Cases.Skin Appendage Disord.2015 Sep;1(2):87-90. doi:10.1159/000435923Triyangkulsri K, Suchonwanit P.Role of janus kinase inhibitors in the treatment of alopecia areata.Drug Des Devel Ther. 2018;12:2323-2335. Published 2018 Jul 27. doi:10.2147/DDDT.S172638Iorizzo M, Tosti A, Starace M, Baran R, Daniel CR 3rd, Di Chiacchio N, Goettmann S, Grover C, Haneke E, Lipner SR, Rich P, Richert B, Rigopoulos D, Rubin AI, Zaiac M, Piraccini BM.Isolated nail lichen planus: An expert consensus on treatment of the classical form.J Am Acad Dermatol.2020 Dec;83(6):1717-1723. doi:10.1016/j.jaad.2020.02.056Frazier W, Bhardwaj N.Atopic Dermatitis: Diagnosis and Treatment.Am Fam Physician.2020 May 15;101(10):590-598.Alobaida S, Lam JM.Beau lines associated with COVID-19.CMAJ. 2020;192(36):E1040-E1040. doi:10.1503/cmaj.201619Haneke E.Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management.Psoriasis (Auckl).2017 Oct 16;7:51-63. doi:10.2147/PTT.S126281National Library of Medicine.Spoon Nails.
Singal A, Arora R.Nail as a window of systemic diseases.Indian Dermatol Online J.2015;6(2):67-74. doi:10.4103/2229-5178.153002
Schons KR, Knob CF, Murussi N, Beber AA, Neumaier W, Monticielo OA.Nail psoriasis: a review of the literature.An Bras Dermatol.2014;89(2):312-317. doi:10.1590/abd1806-4841.20142633
National Psoriasis Foundation.Hands, Feet and Nails.
Singh SK.Finger nail pitting in psoriasis and its relation with different variables.Indian J Dermatol.2013 Jul;58(4):310-312. doi:10.4103/0019-5154.113955
American Academy of Dermatology Association.What is nail psoriasis, and how can I treat it?
Bentaleb I, Abdelghani KB, Rostom S, Amine B, Laatar A, Bahiri R.Reactive Arthritis: Update.Curr Clin Microbiol Rep.2020 Sep 26:1-9. doi:10.1007/s40588-020-00152-6
Chung BY, Choi YW, Kim HO, Park CW.Nail Dystrophy in Patients with Atopic Dermatitis and Its Association with Disease Severity.Ann Dermatol.2019 Apr;31(2):121-126. doi:10.5021/ad.2019.31.2.121
Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia.2017;55(3):131-135. doi:10.5114/reum.2017.68912
Pasch MC.Nail Psoriasis: A Review of Treatment Options.Drugs.2016 Apr;76(6):675-705. doi:10.1007/s40265-016-0564-5
Rigopoulos D, Stathopoulou A, Gregoriou S.Small Molecules and Biologics in the Treatment of Nail Psoriasis.Skin Appendage Disord.2020 Jun;6(3):134-141. doi:10.1159/000507298
Johns Hopkins Medicine.Pemphigus Vulgaris.
Noriega L, Criado P, Gabbi T, Avancini J, Di Chiacchio N.Nail Sarcoidosis with and without Systemic Involvement: Report of Two Cases.Skin Appendage Disord.2015 Sep;1(2):87-90. doi:10.1159/000435923
Triyangkulsri K, Suchonwanit P.Role of janus kinase inhibitors in the treatment of alopecia areata.Drug Des Devel Ther. 2018;12:2323-2335. Published 2018 Jul 27. doi:10.2147/DDDT.S172638
Iorizzo M, Tosti A, Starace M, Baran R, Daniel CR 3rd, Di Chiacchio N, Goettmann S, Grover C, Haneke E, Lipner SR, Rich P, Richert B, Rigopoulos D, Rubin AI, Zaiac M, Piraccini BM.Isolated nail lichen planus: An expert consensus on treatment of the classical form.J Am Acad Dermatol.2020 Dec;83(6):1717-1723. doi:10.1016/j.jaad.2020.02.056
Frazier W, Bhardwaj N.Atopic Dermatitis: Diagnosis and Treatment.Am Fam Physician.2020 May 15;101(10):590-598.
Alobaida S, Lam JM.Beau lines associated with COVID-19.CMAJ. 2020;192(36):E1040-E1040. doi:10.1503/cmaj.201619
Haneke E.Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management.Psoriasis (Auckl).2017 Oct 16;7:51-63. doi:10.2147/PTT.S126281
National Library of Medicine.Spoon Nails.
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