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Dents on Nails: Causes When Small, Vertical, Horizontal & Treatment

Dents in the nails are small depressions forming on nails and are often referred to as nail pits. In many cases, the small depressions may arise without any particular reason, or they may occur due to vitamin deficiency. Let’s find possible causes and treatment of dents on nails.

Causes of dents in nails

Nails are made up of a protein called keratin. This protein component forms on both the fingers and toes. The work of keratin is to protect the nail bed and nerve endings. It is important to note that healthy nails are normally free from dents, spots, brittleness, and breakage.

However, nails that split, break easily, and dent may be an indication of an underlying cause that may be in the urgent need to check.  Below are some of the known possible causes of dents in nails:

Injury

An injury from physical activities or manual work or direct accident or frequent nail biting can cause the nails to split and dent.

Psoriasis

Psoriasis is a skin condition that can cause dry plaques to appear on any part of the body. Psoriasis other than causing flare-ups of symptoms on the skin, it is also known to cause splits and dents on fingernails and toenails.

However, several medications can be administered to get rid of this condition, and some of such medications include salicylic acid creams, steroid creams and injections, tar preparations, vitamin D supplements, and anthralin creams. When one is suffering from psoriasis, they should avoid drinking excess alcohol as it can trigger more symptoms of psoriasis.

Alopecia Areata

Alopecia areata is a condition that causes total or partial hair loss. This condition can also cause dents in the fingernails.

Reiter syndrome

Reiter syndrome is a type of arthritis that occurs in response to a bacterial infection.  The symptoms of this syndrome include swelling and pain in the joints, inflammation of the urinary tract, and eyes.

According to the University of Maryland medical school, Reiter syndrome results in severe damage and modification to the production of keratin (a protein that plays a role in the structure of the nails), and this further results in dents in fingernails, especially in women.

According to the University of Maryland medical school, medical treatment for Reiter syndrome includes immunosuppressant, nonsteroidal anti-inflammatory drugs, and tumor necrosis factor inhibitors.

Fungal infection

Fungal disease of the nails usually accompanies itself with symptoms like bright white discoloration, a yellow hue, splits, and dents on nails. And sometimes, when the nails are overwhelmed by the activity of the fungal disease, the nails can become thicker and brittle in texture.

Incontinentia pigmenti

Incontinentia pigmenti, though uncommon, is a genetic disorder that arises as a result of mutations within the genes, especially IKBKG genes. This disorder is usually characterized by symptoms such as dry patches on the skin, lines of hypo-pigmentation on legs and arms during adulthood. Also, split and dents in the fingernails and toenails may occur.

Circulatory problems

Blood circulation problems in the body due to underlying conditions such as anemia and high blood pressure can affect to a greater extent the health of fingernails and toenails, resulting in the appearance of dents and splits in nails.

Vitamin Deficiency

An unhealthy diet and poor body absorption of vitamins result in vitamin deficiency. Vitamin deficiency, such as B-vitamins, which plays an important role in cell growth and deficiency of vitamin B-12, which strengthens nail growth, can result in fingernail splits and dents accompanied by white spots.

Also, lack of vitamins such as Vitamin C, calcium, iron, and zinc can result to nail abnormalities such as koilonychia and others. You need to visit your doctor for consultation and examination if you notice discoloration such as greenness and yellow nails.

Raynaud’s phenomenon (RP)

Raynaud’s phenomenon is a disorder resulting from a series of discolorations of the fingers or toes after exposure to cold temperatures. This discoloration happens due to abnormal spasm of blood vessels that further affects blood flow to tissues.  This hindrance of blood flow to tissues can result in dents and splits on fingernails.

Chemotherapy

Dents and splits may also appear in cancer patients who are undergoing chemotherapy treatment.

Thyroid disease

The decrease in thyroid production is known as hypothyroidism, and it a condition that usually affects women who are over 50 years of age. Hypothyroidism does not cause noticeable symptoms in its early stages. At the early stages, it may cause symptoms such as thin, split, dented, and brittle nails. However, as time goes, hypothyroidism results in soft slow-growing nails with pale nail beds. Hypothyroidism can also cause more problems beyond spit and weak nails such as chronic conditions like pain in the joints, obesity, and infertility.

Other causes

Other possible causes of dents on fingernails may include diabetes, medications, stress, hypocalcemia, cysts, and cancer.

Horizontal dents

Horizontal dents in nails run across the fingernail from one side to another and can be a sign of an underlying medical condition. These dents are often deep and may result to multiple lines to appear across the nail.

However, as indicated above, horizontal dents are often a sign of an underlying medical infection that requires examination and treatment. In some people with horizontal dents, the nails may stop growing until the underlying medical infection has been gotten rid of.

Some of the underlying conditions that can be responsible for horizontal dents include:

• Thyroid disease
• Diabetes
• Kidney disease
• Cancer
• Anemia

It is important that when you notice deep horizontal dents on your fingernails or toenails, you visit your doctor for examination, diagnosis, and treatment.

 Small pitted dents in nail beds

‘Small pitted dents in nail beds’ are small depressions appearing on the nail beds. These pitted dents can be shallow or deep, depending on the cause.

In many cases, small pitted dents in nail beds are usually found in people with psoriasis, or In case the pitting happens in people who are not infected with psoriasis. It’s usually a sign of an underlying condition.

Small pitting commonly occurs on fingernails, though it can occur on toenails. In many cases, the fingernail or toenail will have multiple pits or a single pit, which may have an appearance of a thimble.

It is advisable for People with small pitted dents in nail beds, to visit a doctor for examination, diagnosis, and treatment of the potential cause.

Some of the underlying conditions that can be responsible for small pitted dents in nail beds include:

1. Alopecia areata, which causes temporary hair-loss and patches on the scalp.
2. Reactive arthritis is a condition that causes inflammation of joints.
3. Eczema, which is a skin condition that causes the skin to be itchy, cracked, and patchy with flare-ups.
4. Psoriasis, a skin condition that causes inflammation, itchiness, and dryness of the skin.

Vertical lines or ridges

The major cause of vertical lines is aging.  The nails may begin to form single or multiple vertical ridges as they grow.

These lines run from the tip of the finger to the bottom of the nail, and these lines are usually not a cause for concern unless they are accompanied by symptoms such as pain or unsightly color changes. With a change in age, the fingernails and toenails may begin to show signs such as:

1. The nails may become thinner or thicker and break easily.
2. They can also lose their smooth shape.
3. The nails may begin to dent and split.
4. The nail may fissure and become brittle.

These symptoms, especially when you are above 50 years, should not be a cause for concern, but you can visit your dermatology for consultation and possibly examination.

Possible causes of vertical ridges

Anemia

Anemia can cause vertical ridges or dents in nails, and usually, the vertical lines (dents) are accompanied by changes in texture in the nails or color changes.

Splinter hemorrhage.

Splinter hemorrhage is a small blood clot beneath the nail beds, which results in vertical discolorations. It is always advisable to visit a doctor for examination and treatment, in case the cause of this small blood clot is not known.

Other causes

Other underlying medical disorders that can cause vertical ridges to appear on the nail include:

• Trachyonychia
• Peripheral vascular disease
• Rheumatoid arthritis
• Psoriasis
• melanoma

How to prevent fingernail dents

Practicing preventative measures is the surest way of keeping your nails free from dents, lines, ridges, and other disorders, causing nail problems. Try the following simple steps to prevent the development of dents in your fingernails.

1. Eat foods that are rich in minerals and protein.
2. Take foods and supplements that have high contents of zinc and omega 3 fatty acids.
3. Avoid chewing and biting your nails.
4. Avoid putting on very tight shoes that can cause vertical dents on toenails.
5. Reduce the use of nail polishes that contain high contents of harsh chemicals.

Other preventative measures

• Applying a protective layer to protect the nail bed from getting easily damaged by injury and to strengthen the nails.
• Practicing good hygiene, by regularly trimming your fingernail by use of sharp manicure clippers or scissors.
• Regularly use a moisturizer on your fingernails and cuticles.
• Always keep your fingernails dry and clean to prevent infectious bacteria from growing under your fingernails.

When to see a doctor

It is important to note that not all fingernail conditions are normal, visit your doctor for consultation and examination when you experience the following:

• If there is thickening or thinning of the nails.
• If your nails have failed to grow normally.
• If there are some bleeding and small blood clots around the nail bed.
• If you are experiencing swelling or pain around the nails.
• When your nails have separated themselves from the nail bed and surrounding the skin.
• When there are changes in the shape of your nails, such as nail curling.
• When there are changes in color, like discoloration of the entire nail or a dark streak under the nails.

Treatment options

A host of different factors causes dents on nails. The treatment of this condition is done after identifying the underlying cause through various sessions of examination and diagnosis; in other words, treatment is done on a case by case basis after identification of the cause.

Below are various treatments that can be administered to various causes;

NAIL PSORIASIS

1. Psoriasis can be treated through the application of salicylic acid creams to the skin or by the use of steroid injections.
2. it can also be treated by eating a healthy diet full of vitamins and minerals or avoiding factors that cause skin inflammation, flare-ups, and dryness.

REITER SYNDROME

1. To deal with Reiter syndrome, medications that prevent secondary infections such as antibiotics and medications that suppress the response of the immune system like cyclosporine can be prescribed by your doctor.
2. This condition is sometimes accompanied by pain and inflammation. In this case, anti-inflammatory medications can be prescribed by your doctor.
3. To completely get rid of this condition, your doctor may administer TNF (Tumor Necrosis Factor) inhibitors.

ALOPECIA AREATA

1. To get rid of alopecia areata, your doctor can consider prescribing, topical immunotherapy, and creams with corticosteroids.
2. In cases were alopecia areata has severe symptoms, ultraviolet light therapy and corticosteroid injections may be administered to get rid of other symptoms accompanying alopecia.

FUNGAL INFECTION

1. In cases whereby the fungal infection is accompanied by many other symptoms such as dents on nails, your doctor may recommend antifungal injections.
2. Also, in this case, oral or topical antifungal medications may be prescribed by your doctor.

CIRCULATION PROBLEMS

1. Your doctor may recommend physical exercises to improve blood circulation and avoiding exposure to extremely cold temperatures.
2. Also, your doctor may recommend medication that boosts blood circulation in your body or medications that prevent the blood from coagulation.

RAYNAUD’S PHENOMENON

1. Your doctor will recommend massage and ensure that you stay away from areas of cold temperatures.
2. Also, your doctor can conduct electrotherapy to get rid of Raynaud’s phenomenon symptoms or complications.

INCONTINENTIA PIGMENTI

1. Your doctor will recommend topical corticosteroid creams, topical tacrolimus, and skin moisturizers.
2. Antibiotics are also very powerful in getting rid of this condition, as they help to prevent secondary infection.

VITAMIN DEFICIENCY

• Your medical doctor may recommend vitamin-rich supplements and recommend changes in diet, which may involve eating too much of green vegetables and fruits.

THYROID PROBLEMS

• To get rid of thyroid problems, your doctor will administer thyroid hormones in your body to restore hormonal balance.

INJURY

• After nail injury, you must seek medical care for the injury and practice good nail hygiene during the recovery period.

References

1. https://www.healthline.com/health/skin-disorders/nail-pitting
2. https://www.medicalnewstoday.com/articles/319321.php