Pitting in Nails: Causes to Know

Nail pitting appears as pinpoint depressions because nail formation has been interrupted. It may affect one nail after local trauma or several nails with an inflammatory skin condition. Nail psoriasis can also cause separation from the nail bed, thickening, crumbling or colour change, but pitting alone does not establish a diagnosis. Skin plaques, joint stiffness, scalp scale or changes in other nails give a clinician useful context.

Take a clear photo and note whether new pits appear as the nail grows. Keep nails trimmed, protect them from biting and repeated manicure trauma, and moisturise surrounding skin. Do not scrape the surface to remove pits. A clinician may examine the skin and nails and discuss options such as [Steroid Injection Into The Skin](/treatments/injectables/intralesional-steroid-injection/) or [Biologic Therapy](/treatments/medical-dermatology/biologic-therapy/) when the underlying condition warrants them. Related colour changes are described under [Discoloured Nails](/symptoms/nail-discoloration/).

Arrange a review if pitting affects several nails, progresses, or occurs with pain, swelling, nail lifting, marked crumbling or skin rash. Prompt assessment is also sensible for a dark streak, bleeding or a nail change after significant injury. Do not diagnose the cause from photographs alone; examination helps separate inflammatory disease from trauma and infection.

What pattern do my pits follow? Could psoriasis or another inflammatory condition affect my nails? Should my joints or skin be checked? Which treatment fits the cause?