What Causes Nail Pitting, and Do You Treat It?

It’s easy to take your fingernails for granted, but they play an important role in protecting the tips of your fingers and allowing you to pick up small objects. And sometimes, changes in the appearance of your fingernails can give you important clues about your overall health. 

For example, some nail changes can be a sign of a new medical condition. Nail pitting — or small pits in the nail — can be normal, but it can also be a symptom of some autoimmune conditions. 

If you’ve noticed new nail pits, here’s what it could mean and what you should do next.  

What is nail pitting? 

Nail pitting is a nail change in which small dents develop across the surface of the nails. The dents or “pits” are usually quite small — about the size of a pinhead. Nail pitting can happen when there’s damage to the nail matrix. The nail matrix is made of special cells that create new fingernails or toenails. You can see part of your nail matrix. The lunula, which is the white crescent at the base of your nail, is part of your nail matrix. But the rest of your matrix isn’t visible because it’s covered by the base of your nail and your cuticle. 

What can cause nail pitting?

Medical conditions that can damage nail matrix cells cause nail pitting. Some medical conditions cause inflammation in the cells of the nail matrix. This inflammation damages the cells so they can’t produce normal nails. But nail pitting can also develop for no reason. 

“Nail pitting can sometimes be seen in people as a normal finding, meaning it's not related to any underlying condition,” said Dr. Maria Robinson, a board-certified dermatologist and GoodRx contributor. “It can also be seen in skin conditions, like psoriasis, alopecia areata, chronic eczema, and lichen planus.”

Let’s look more closely at conditions that can cause nail pitting. 

Psoriasis

Psoriasis is an autoimmune condition that can lead to thick, raised patches of skin anywhere on the body. 

Psoriasis can also affect the nails, causing:

• Nail pitting

• Brittle nails

• Color changes including white or yellow nails 

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“Nail pitting is the most common nail change seen in people who have psoriasis,” Robinson said. These changes can be the first — and sometimes only — sign of psoriasis. People with nail psoriasis usually also have psoriasis patches on their skin, too. But sometimes people with psoriasis only develop psoriasis on their nails. 

Alopecia areata

Alopecia areata is an autoimmune condition that causes patchy hair loss. It usually affects hair on the scalp and face, but can cause hair loss on any part of the body. 

And it can also affect the nails. People with alopecia areata may notice nail changes, such as:

• Nail pitting 

• Brittle nails 

• Fragile nails

• Rough nails 

About 30% of people with alopecia areata experience nail changes, and nail pitting is the most commonly reported change. 

Eczema 

Eczema, or atopic dermatitis, is a common inflammatory skin condition that causes a dry, itchy rash. People with chronic eczema can also experience nail changes, including:

• Nail pitting 

• Horizontal lines or ridges

• Texture changes, like thickened nails

• Discoloration 

• Split nails

In one study, 10% of people with eczema also develop nail changes. Nail pitting was the second most commonly reported change in nail appearance.

Lichen planus

Lichen planus is an inflammatory condition that affects the skin, scalp, and the lining of the mouth, anus, and genitals. It’s not clear why some people develop lichen planus. 

People with lichen planus often develop raised, itchy bumps on the hands and legs. They also develop nail changes including:

• Nail pitting 

• Ridges

• Texture changes like rough or thin nails

• Nail loss

About 10% of people with lichen planus develop nail changes. Nail changes can happen even if the skin on the hands doesn’t show signs of lichen planus. 

How do you treat nail pitting?

Treatment for nail pitting depends on what’s causing the pitting. For example, people with psoriasis and nail pitting should receive treatment for psoriasis. Treatment can get psoriasis under control and ease skin and nail changes, including nail pitting. 

The same is true for eczema, alopecia areata, and lichen planus. Getting treatment for the condition causing the nail pitting is often enough to stop ongoing damage to the nail matrix. Once the matrix recovers, it will start producing normal nails again, and changes like nail pitting will go away. 

Some people need additional treatment to help their nail pitting. Some treatment options work directly on the nails to stop inflammation at the nail matrix. Options include: 

• Topical medications: Topical steroids or vitamin D derivatives can help ease nail matrix inflammation and correct nail changes. 

• Steroid injections: Some people may need steroid injections underneath their nails. This gets the steroids closer to the nail matrix to help ease inflammation. 

• Laser treatments: Laser therapy uses different wavelengths of light to help the nail matrix create new, healthy nails.

People who have isolated nail pitting — that is, nail pitting but no other signs of another medical condition — may also benefit from these treatments. 

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Written by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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