What should you know about nail pitting in psoriatic arthritis?

Pits look like tiny pinpricks or shallow dents across one or more fingernails or toenails. They form when inflammation affects the part of the nail that produces the nail plate. The nail may also become ridged, discoloured, crumbly, thicker, or separate from the skin beneath it. Nail changes can accompany psoriasis or psoriatic arthritis, but pitting can have other explanations, including trauma or another nail disorder. A clinician will consider the appearance of the nails together with skin patches, joint pain, joint swelling, or morning joint stiffness.

Nail pitting does not by itself confirm psoriatic arthritis, and its presence does not predict how severe joint disease will be. Photographing changes and noting when they began can make an appointment more useful.

Arrange an assessment if new nail pitting appears, especially when you also have persistent joint symptoms or scaly skin areas. Keep nails trimmed, avoid biting or picking, and protect hands from repeated wet work and irritating chemicals. Use gloves for cleaning and moisturise the nails and surrounding skin after washing. Do not scrape pits away or start prescription treatment without advice; the nail grows slowly, so improvement may take time even after inflammation is controlled. Treatment may focus on the underlying psoriatic disease, with options such as anti-inflammatory medication discussed according to your symptoms and examination. Physiotherapy may help maintain movement and function when joint symptoms are present.

Book a routine appointment for persistent pitting, nail separation, repeated nail changes, or new pain and stiffness in the fingers, toes, wrists, knees, or other joints. Seek prompt medical advice if a joint becomes suddenly very swollen, hot, and painful, or if nail redness and tenderness suggest infection. Urgent care is appropriate when severe pain follows an injury, a finger or toe changes colour, or you cannot use the affected limb normally. Bring a list of symptoms, medicines, skin changes, and family history so the clinician can assess the whole pattern.

Ask whether the nail pattern fits psoriasis, whether your joint symptoms need assessment for psoriatic arthritis, and whether a fungal nail problem or injury could look similar. You can also ask which nail-care measures are suitable, how treatment choices would be monitored, and whether physiotherapy could support painful or stiff joints.