What Causes Fingernail Pitting?

Do you have pitted fingernails? Find out what causes this frustrating problem and what you can do about it.

Some people go to great lengths to keep their nails attractive with regular manicures – so it can be a disappointment when fingernails aren’t strong, smooth, and unblemished. Some nail issues are more than just a superficial problem – they can a sign of undiagnosed health disorders. One such problem is pitted fingernails. What causes pitted nails and what can you do about them?

Nail Pitting Causes: Pitted Nails Can Be a Sign of a Medical Problem

Pitted fingernails shouldn’t be confused with peeling ones. Pitted fingernails have tiny punctuate depressions on their surface – without significant peeling. It almost looks like someone has taken a thin nail and hammered tiny depressions into the nail plate. Pitted nails are a sign that something is disrupting the normal growth of the nail – so that it’s laid down improperly. In contrast, peeling nails occur when the nails are exposed to harsh environmental factors that cause the hard keratin sheet that makes up the nail to separate and peel off.

What Causes Pitted Nails?

The most common cause of pitted fingernails is the skin disease psoriasis. This disease which causes red plaques and silver colored scales on the skin also affects the fingernails in about half the people diagnosed with it. Psoriasis causes the nails to develop “pits” and “dents” that destroy the smooth appearance of the nail. The nails can also develop a yellowish discoloration with white spots and, in severe cases; the entire nail can crumble off.  Needless to say, this is a frustrating problem to deal with.

Other Nail Pitting Causes

Some connective tissue and autoimmune diseases cause pitted fingernails, particularly Reiter’s syndrome, a type of inflammatory arthritis seen mostly in men after an infection. Pitted fingernails can also occur with alopecia areata – an autoimmune diseases associated with hair loss.

If you have pitted nails and any other symptoms such as joint discomfort, swelling, fever, fatigue, or weight loss, it’s a good idea to see a doctor to make sure you don’t have an undiagnosed autoimmune problem.

A bad case of dermatitis on the hands can also cause pitted fingernails by disrupting normal fingernail. Once the dermatitis is treated, the pits will gradually grow out, although it can take several months for the damaged nail to be completely replaced with a new one.

The Bottom Line?

If you have pitted nails and don’t know why, see your doctor to make sure you don’t have a connective tissue or autoimmune problem – especially if you have other symptoms.


Am Fam Physician. 2004 Mar 15;69(6):1417-1424.

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