Nail pitting due to psoriasis L60.8

Superficial, fine, barely 0.1 cm large, round or oval, punctate depressions of the nail plate (surface defects), which may be detectable in one or more nails. These "spots" may be idiopathic or symptomatic following underlying diseases.

Spotting is observed much more frequently on fingernails than on toenails. Spots can appear irregularly scattered, but also grouped, even linearly ordered. They originate in minute, punctate, parakeratotic "pinpoint" lesions in the proximal nail matrix, which is responsible for the cornification process of the hard, upper third of the nail plate. The punctually defective horny material formed breaks out easily, resulting in depressions here, i.e. spots become dimples. Spots grow out distally with the nail plate.

Spotting is not psoriasis-specific. They are also detected in alopecia areata, eczema diseases. They are also said to occur idiopathically.

Lacunarnail plate defects: These are enlarged even deeper variants of pinpoint spots. Lacunar nail plate defects usually occur together with the smaller spots, but also in combination with psoriatic pathologies of the distal nail matrix such as oil spot and distal onycholysis).

Not necessary for medical reasons. Treatment of the underlying disease. Nail gels can be applied to improve the aesthetic appearance.

1. Nanda S et al (2014) Utility of gel nails in improving the appearance of cosmetically disfigured nails: experience with 25 cases. J Cutan Aesthet Surg7:26-31