Pitting in nails and psoriasis: what to know

Pits are tiny depressions in the nail surface. Psoriasis may disrupt the area where the nail plate forms, leaving an uneven pattern as the nail grows. You might also notice lifting from the nail bed, thickening, colour change, crumbling, or a small area of scaling near the nail. Some people have nail changes without an obvious skin rash, while others have psoriasis elsewhere on the body. A fungal nail infection, eczema, repeated injury, or another inflammatory condition can resemble nail psoriasis, so appearance alone cannot confirm the diagnosis.

Arrange a dermatology assessment if pits persist, spread, or occur with other nail changes. Take a clear photograph in natural light and note when the changes began. Keep nails trimmed, avoid picking beneath them, and wear gloves for wet work or contact with irritating products. Moisturising the hands and the skin around the nails can reduce dryness and cracking. Do not start steroid or antifungal treatment on the nail without advice, because the right treatment depends on whether the nail matrix, nail bed, or nearby skin is involved. Learn more about Psoriasis and related symptoms such as Dry Skin or Itchy Skin.

Book a routine appointment for new or unexplained pitting, especially when several nails are affected or you have joint stiffness, swollen fingers, or scaly skin. Seek prompt care if the nail becomes very painful, rapidly separates, drains pus, or the surrounding skin becomes hot and increasingly red. These features can indicate infection or a different problem that needs timely treatment.

Could this be nail psoriasis, an infection, or damage from repeated trauma? Which parts of the nail are involved? Do I need a nail sample or examination of my skin and joints? What nail-care steps should I follow while waiting for treatment?