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Nail surface changes: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Changes in the surface of the nails include pinpoint depressions and grooves.
Point depressions on the surface of the nail plate are essentially small erosive defects of the nail keratin. Their presence may be a normal variant - a healthy person may have up to 5 point depressions on the surface of all twenty nails. Most often, superficial point depressions indicate the presence of psoriasis (the "thimble" symptom). Similar manifestations may be in patients with alopecia areata, Reiter's disease, lichen planus, and lichen rosea. Deeper and rougher depressions are found in eczema, atopic dermatitis, and allergic dermatitis. Multiple deep depressions are diagnosed in patients after contact with aggressive liquids (concentrated acids and alkalis) in production when using pure acetone to remove decorative coatings or artificial nails.
Grooves on the surface of the nail can be longitudinal and transverse, single and multiple.
A single longitudinal groove on the nail plate occurs in a mucoid cyst of the tendon sheath, after a nail injury involving the nail matrix, and in Heller's median canaliform dystrophy. As a rule, one nail is involved in the pathological process, most often the first finger of the hand. A characteristic symptom of a change in the nail plate is the appearance of a "fir branch": small and superficial transverse grooves extend at an angle from a deep longitudinal median groove. The longitudinal groove can be very deep and lead to a violation of the integrity of the nail. Often, this idiopathic dystrophy has a wave-like course - a smooth nail plate can grow back, and then a groove appears again. The main methods of correcting Heller's median canaliform dystrophy are nail protection, in particular, using artificial nail technologies. Heller's dystrophy should be differentiated from the above conditions, as well as from onychotillomania.
Impaired microcirculation in the nail bed area is one of the most common causes of changes in the nail surface. Multiple longitudinal grooves are found in neurocirculatory dystonia, Raynaud's syndrome, diffuse connective tissue diseases (systemic lupus erythematosus, scleroderma, etc.), obliterating endarteritis, atherosclerosis of the vessels of the upper and lower extremities. The simultaneous combination of multiple longitudinal grooves and a jagged edge of the nail plate, indicating increased fragility of the nail plate, can be a symptom characteristic of onychomycosis and Darier's disease.
Transversely located grooves, or Bo-Reilhe grooves, may indicate a severe somatic or infectious disease (hepatitis, flu, etc.). Bo-Reilhe grooves may indicate impaired zinc absorption in gastrointestinal diseases. This phenomenon occurs in such dermatoses as atopic dermatitis, eczema, allergic dermatitis, psoriasis, low-grade skin lymphomas, and indicates an exacerbation of the underlying disease. Taking into account the speed characteristics of nail plate growth, a specialist can indicate with some accuracy the timing of any adverse effect on the nail matrix.
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