Ridged Nails

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Introduction

Have you ever seen faint lines, grooves, or indentations on your toenails or fingernails? These are possibly ridges in nails, something that is fairly common and can occur either vertically or horizontally. Although vertical ridges in nails can be a normal process with aging, more apparent or irregular changes—like horizontal ridges in nails or nail pitting—may occasionally be a sign of deeper health issues, including ridges in nails thyroid problems. These nail modifications can indicate nutritional deficiencies, autoimmune disorders, or metabolic imbalances. Knowing the reasons, patterns, and remedies for such nail transformations is vital—not just for nail health, but for your overall health. This blog examines the science of such nail indicators, bringing together contemporary medical science and Ayurveda knowledge.

What are the Causes of Ridged Nails?

Ridges in nails can arise from a variety of factors, ranging from minor trauma to more significant systemic conditions. Understanding the etiology is essential for successful management.
Trauma: Direct injury to the nail matrix, or the part of the nail where the nail develops, may result in the development of longitudinal ridging and splits.
Infections: Paronychia or infection around the nail can change the color and appearance of the nail, usually by creating ridging.Chronic paronychia, for instance, has been seen to produce horizontal ridges in nails and grooves in the nail plate.
Systemic Conditions: Psoriasis and alopecia areata are common diseases that are often presented with ridges in nails.

- Although vertical ridges are normal with aging, horizontal ridges in nails (Beau’s lines), addition to other symptoms, may be a symptom of thyroid disease.
- Lichen planus and rheumatoid arthritis may also be associated with longitudinal ridging.
- Severe eczema and circulatory conditions, such as Raynaud’s disease, may also cause nail ridging.
- A specific type of unusual longitudinal ridging called trachyonychia is linked to inflammatory conditions and can happen in psoriasis, alopecia areata, and lichen planus.

Nutritional Deficiencies: Poor intake of some nutrients can cause abnormalities in nails. Biotin and protein deficiency has been proposed to influence nail status. Central ridges in nails are also a sign of iron or folic acid deficiency.
Medications: Certain medicines influence the growth of nails and their overall health, which may result in ridging as a side effect.
Genetic Factors: Some nail diseases, like twenty-nail dystrophy, can be genetic, resulting in typical ridging on all nails. Brachyonychia, or the narrowing of the nail width in relation to its length, is also a finding in hyperparathyroidism and psoriatic arthropathy.
Aging: As a part of normal physiology, the exaggeration of longitudinal ridging is frequently seen in the nails of old people.
Space-Occupying Lesions: Cysts like the myxoid cyst or fibromas which locate themselves inside the nail fold might compress the nail matrix and can present clinically as concave longitudinal groove or ridges in nails plate.

What are the Symptoms of Ridged Nails?

The symptoms of ridged nails can vary with the cause, but common presentations are:

Longitudinal ridging: From the cuticle to the nail tip, the most characteristic feature is the presence of longitudinal, vertical ridges on the nail plates. In diseases such as trachyonychia, the nail plate becomes rough and dull in appearance.

Brittleness: Ridged nails are also brittle and prone to splitting or breaking. This is seen specifically in onychoschizia when there is distal peeling and lamellar separation.

Nail Texture Changes: The nails might lose their natural shine and become rough or dull in texture.

Color Changes: Ridged nails may, at times, develop discoloration, including yellowing or opalescence, that can be observed in diseases such as lichen planus or systemic disorders.

Paronychia that’s chronic may also result in the abnormality of the nail plate appearance.
Psoriasis may involve typical ‘oil-drop’ discoloration, hyperkeratosis, and onycholysis.

Associated Signs: Depending on the underlying cause, ridged nails may be associated with other nail diseases like nail pitting (tiny, discrete depressions), onycholysis (separation of the nail plate from its bed), or alterations in the nail bed itself.

Pain/Discomfort: Some diseases leading to ridging, such as chronic paronychia may induce severe pain or discomfort.

Thinning/Atrophy: Lichen planus and alopecia areata can result not just in ridging but also in thinning of the nail plate.

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Diagnosis of Ridged Nails

Clinical Inspection: Ophthalmic inspection of all 20 nails for ridging, brittleness, color changes, and other abnormalities.
Evaluation of Related Conditions: Observe for manifestations of systemic disease or cutaneous disorders on hair and skin.
Dermoscopy (Onychoscopy): Utilises a dermatoscope to magnify and observe the nail and adjacent structures.
Nail Biopsy: If findings are inconclusive clinically or in the presence of suspected underlying serious condition, a biopsy of the nail matrix or involved nail unit area may be required.
Laboratory Tests: Further tests can be requested depending on the suspected underlying condition, such as microscopic examination, fungal or bacterial cultures, radiographic studies, and blood tests.

Ayurvedic Treatment for Ridged Nails

Nail disorders, such as ridging, in Ayurveda fall under the category of “Kunakha,” which describes diseases caused by imbalances in the doshas. Treatment is from a holistic perspective and focuses on correcting the imbalance.

Ridges in nails usually appear due to vitiated Vata and Pitta doshas that act on the Asthi dhatu (bone tissue).

Herbal Remedies: Herbs such as Indian gooseberry can be helpful based on its high antioxidant and vitamin C content, which enhances nail strength.
Dietary Changes: Foods with natural oils such as nuts, seeds, and green leafy vegetables, to nourish the bone and nail are recommended. Consuming ghee and other seasonal and regional oils in cooking is recommended.
Topical Remedies: Herbal ointments (lepa) and pastes are also locally applied. Snehana (oleation) and Swedana (fomentation) therapies, including oil massage and application of heat at the site, are employed to relieve pain and inflammation.
Panchakarma: Therapies such as Virechana (purgation) and Vamana (emesis) are used to eliminate doshas based on the degree of vitiaiton. Shirodhara (oil pouring on the head) releases tension and helps balance the doshas.
Lifestyle Changes: Exercise regularly and keep yourself well-hydrated. Ayurveda also recommends avoiding activities like nail biting or tapping of nails with force.
Jalaukavacharana (Leech Therapy): Leech therapy has been found useful in curing infections of the nail bed (Kunakha) because leech saliva imparts anti-inflammatory and anti-fungal property.

Home Remedies for Ridged Nails

While home remedies may not address underlying medical conditions, they can help improve ridges in nails.

Moisturizing: Daily or frequent application of moisturizers or natural oils such as coconut oil or olive oil can be used to maintain the nails’ hydration, which can lower the visibility of ridges.
Dietary Modifications: Adding foods such as eggs, almonds, ghee, ground nut and leafy greens is helpful.
Prevention of Trauma: Keeping your nails away from physical trauma, like too much filing or exposure to harsh chemicals, can avoid additional damage and ridging.
Topical Therapies: There are a variety of topical therapies including dabbing the area with coconut oil (or castor oil), applying aloevera gel on the area, moisturisers etc.
Hydration: Drinking lots of water and being well-hydrated also directly contributes to overall nail health.
Avoidance of Aggressive Techniques: When caring for nails, gentleness (ie. If you have to remove polish-don’t scrape it off. Use an acetone free nail polish remover). Additionally, for integrity of the nails, do not bite your nails!

When to Seek the Doctors

Although ridged nails can be benign, some signs necessitate a trip to a medical practitioner for appropriate diagnosis and treatment.

Recurring Changes: If ridged nails do not change or improve, it can be a sign of an underlying disease.
Related Symptoms: When ridged nails are accompanied by pain, color change, nail thickness modification, or abnormal growths, it can indicate fungal, bacterial, or systemic infection.
Underlying Health Conditions: Individuals with pre-existing health conditions should seek medical advice if they notice changes in their nails.
Nail Trauma: If ridged nails develop after significant trauma, it’s crucial to assess to rule out serious damage or infection.
Cosmetic Concerns: If ridged nail appearance causes distress or impacts quality of life
Suspicion of Serious Conditions: A nail biopsy is mandatory for persistent subungual hemorrhage, chronic unexplained onycholysis, and persistent warts.

Conclusion

Ridges in nails are a common nail finding that can range from a sign of aging to an indicator of more serious underlying health conditions. Ayurveda therapies such as abhyanga, swedana along with dietary modification, home remedies can be beneficial in cases of nail pitting, horizontal ridges in nails and other deformities of the nail. Seeking the guidance of a physician is important as the symptom may arise due to serious underlying causes such as psoriasis, hypothyroidism. Maintaining proper hygiene and nutrition is important.

FAQs

What are ridges in nails and what do they mean?

Ridges in nails are linear depressions or elevations on the nail plate surface, which can appear horizontally or vertically. They can be a normal part of the aging process, but may also indicate underlying trauma, infections, or systemic health conditions.

What causes ridges in fingernails or toenails? Ridges i

Ridges in fingernails or toenails can be caused by various factors, including physical trauma to the nail matrix, infections like paronychia, and systemic conditions such as psoriasis or lichen planus. Nutritional deficiencies, certain medications, and genetic predispositions can also contribute to their formation.

Are ridged nails a symptom of psoriasis?

Yes, ridged nails are a common symptom often seen in psoriasis, particularly as longitudinal ridging and other texture changes like nail pitting or trachyonychia. These nail manifestations indicate involvement of the nail matrix by the psoriatic disease process.

What causes weak nails with ridges and thinning?

Weak nails with ridges and thinning can result from conditions like lichen planus, which causes longitudinal ridging and thinning of the nail plate, potentially leading to permanent scarring. Alopecia areata can also lead to thinning of the nail plate, ridging, and brittleness.

How is nail pitting different from nail ridging?

Nail pitting refers to small, round depressions on the surface of the nail plate, typically caused by a disease process in the proximal nail matrix. In contrast, Ridges in nails (onychorrhexis) presents as longitudinal lines, grooves, or elevated ridges on the nail surface, which can be normal with aging or signify conditions like lichen planus or circulatory disorders.

REFERENCES

Tanzi, E. L., & Scher, R. K. (1999). Managing common nail disorders in active patients and athletes. The Physician and Sportsmedicine, 27(9), 35–47.

Gordon, K., et al. (2011). Trachyonychia: a comprehensive review. Indian Journal of Dermatology, Venereology and Leprology, 77(6), 640–645.

Pelzer, C., & Iorizzo, M. (2024). Alopecia Areata of the Nails: Diagnosis and Management. Journal of Clinical Medicine, 13, 3292.

Parveen, T., & Sharma, R. (2023). An Ayurvedic Approach to Paronychia w.s.r. to Kunakha: A Single Case Study. AYUSHDHARA.

Milani, M., & Adamo, L. (2022). Successful Treatment of Nail Lichen Planus with a Lacquer Containing Urea, Keratinase, and a Retinoid Molecule: Report of 10 Cases. Case Reports in Dermatology, 14, 43–48.

Topal, I., et al. (2016). Nail abnormalities in patients with vitiligo. Anais Brasileiros de Dermatologia, 91, 442–445.

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