Potential Causes of Longitudinal Ridging

Longitudinal ridging refers to the vertical raised lines present on the nails. There may also be discoloration and thickening of the nails along with the ridging. A certain number of lines are normally found on all fingernails, due to the basic aging process. They do not necessarily signal the presence of a health issue.

However deeper ridges, discolored nails and jagged edges of brittle nails may be symptomatic of other underlying conditions. Longitudinal ridging may be caused by a host of potential medical issues and may be a good reason to pay attention to the person’s general health and wellbeing.

Possible causes of longitudinal ridging can include:

Lichen planus

A chronic skin condition that affects one in a hundred people, Lichen Planus causes longitudinal ridging in about 10% of people affected with the disorder. It is an autoimmune disease in which the inflammatory cells attack an unknown protein in the body.

Besides affecting the nails, it can cause a number of lesions on the skin as well as mucosal surfaces. It is also called “twenty nail dystrophy” if all the nails of the fingers and toes are affected.

Myxoid cyst

The myxoid cyst may also be called a mucous cyst, a digital ganglion cyst or a digital synovial cyst. In this case a cyst is formed in the skin around the nail and puts pressure on the root of the nail. As a result the nail develops a lateral groove extending outwards.

This kind of longitudinal ridging is caused due to the degeneration of the connective tissue on the top segment of the finger. Usually once the cyst has been treated and healed, the longitudinal ridging also manages to disappear once the nail outgrows it.

Darier’s disease

A genetic disease that is classified as a hereditary acantholytic dermatosis, Darier’s disease is inherited via an autosomal dominant gene. Thus a single parent can pass it on to the child. It is considered a benign disorder and may escape diagnosis in many people.

It is also often misdiagnosed as other skin conditions but a skin biopsy is the best diagnostic tool to identify it. Longitudinal stripes of white and red tend to affect the nails of people with Darier’s disease. There is also a v-shaped nick on the top of the nail which is typically characteristic of the disorder.

Psoriasis

This chronic skin condition is classified as an immune-mediated inflammatory disease, which affects approximately 4% of the world’s population. It affects the skin causing red, scaly patches which can be itchy. The skin becomes very dry and may crack causing fissures and bleeding.

The nails are also affected by discoloration, longitudinal ridging and they become extremely brittle. There is no permanent cure and psoriasis flares up and reduces throughout the person’s life.

Psoriasis of the hand

Alopecia areata

Alopecia refers to hair loss. In alopecia areata a thinning of the hair results in a bald patch on the scalp. It can show up as a single big patch or a number of smaller ones on the scalp. Eyebrows and eyelashes may also be affected.

Longitudinal ridging and pitting of the nails may show up in 15% cases of people who suffer from alopecia areata. It can be triggered by a viral infection, trauma, or a hormonal change, with emotional and physical stress possibily resulting in aggravation of the preexisting condition.

Onychomycosis

Onychomycosis is essentially a fungal nail infection - it can be caused due to yeasts, moulds and dermatophytes. It is rarely seen in children, but is found in older people. The condition may affect a single nail or more, with a higher likelihood of affecting toenails than finger nails.

It is usually seen in either the great toenail or the little toenail. A whitish yellow stripe can be present on the side of the nail and longitudinal ridging may be seen. Some cases may show a complete destruction of the nail while others may have partially crumbled or flaky nails.

Anemia

A condition in which the red blood cells decrease usually due to deficiency of iron, vitamin B12 or folic acid is called anemia. Iron deficiency alone may be responsible for triggering skin problems. Associated effects can include brittle and fragile nails which may develop vertical ridges or lines. Supplements are the best way to handle the nutritional deficiency causing anemia.

Peripheral vascular disease

Peripheral Vascular Diseases (PVDs) are conditions affecting the circulation system. They affect the blood vessels, both arteries and veins. The vessels narrow due to arteriosclerosis or building up of plaque within the vascular tubes. This constriction makes it difficult to maintain optimal levels of blood and oxygen flow to internal organs.

Organs usually affected by PVDs include the limbs and those placed below the stomach. The distance from the heart makes these blood vessels the peripheral vessels, hence the name of the disorder. The poor blood supply affects the nails and causes longitudinal ridging.

Reviewed by Afsaneh Khetrapal, BSc (Hons)

References

  1. http://www.aafp.org/afp/2004/0315/p1417.html
  2. http://www.pcds.org.uk/clinical-guidance/nails
  3. http://www.dermnetnz.org/topics/nail-terminology/
  4. http://www.webmd.boots.com/healthy-skin/guide/ridges-in-fingernails

Further Reading

Last Updated: Jan 16, 2017

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