In addition to psoriasis, what conditions cause nail pitting? What can be done about it?
—Sandra Willingmyre, MD, Camden, N.J.

Nail pitting occurs in response to pathology in the nail matrix, mostly the proximal matrix. Pits present as shallow depressions in the nail surface and can vary in size. Primarily associated with psoriasis, pitting can also be seen in alopecia areata and eczematous dermatitis. While a number of treatment alternatives currently exist for nail disease, including pitting, there is a general paucity of clear evidence regarding these choices. For psoriatic nail pitting, the traditional therapy has been intermittent intralesional steroid injections to the proximal nail folds. Given the pain and temporary nature of improvement, most patients opt against this therapeutic option. Nail improvement may occur in some patients on systemic therapy for moderate-to-severe psoriasis. Data are currently insufficient to indicate which therapies may be more effective.
—Jeffrey M. Weinberg, MD (124-5)