Longitudinal Ridging: Causes, Treatment, and When to See a Doctor
Longitudinal ridging on the nails is a common occurrence many people experience at some point in their lives. Here is an in-depth look at what causes ridging, when it could indicate an underlying condition, and how to reduce the appearance of unsightly ridges.
What Exactly is Longitudinal Ridging?
Longitudinal ridges refer to the vertical ridges or bands that run from the cuticle at the base of the nail down towards the tip. This ridging pattern runs parallel to the normal growth direction of the nail.
These ridges can vary from small and barely noticeable to deep, almost grooved indentations in the nail plate. Ridges may occur on just a few nails, or affect all nails on the hands and/or feet.
In medical terminology, the medical name for longitudinal ridging is “onychorrhexis.” It is not to be confused with horizontal nail pitting, leukonychia, or Beau’s lines, which have a different pattern of ridges or discoloration.
Longitudinal ridges typically feel smooth when running a finger across them. They do not interrupt the continuity of the nail surface like breaks or pits would.
The ridges tend to be more prominent near the center of the nail and fade out towards the edges. Thicker nails also show more noticeable ridging.
What Causes This Type of Ridging to Develop?
There are a number of potential causes for longitudinal nail ridges. Some are harmless nail changes seen in healthy aging, while others may indicate an underlying medical disorder.
One of the most common causes of nail ridging is simply aging. As we get older, our nails tend to lose moisture, elasticity and thicken. This makes the nails more prone to developing ridges and grooves with normal fingernail growth.
Aging-related nail ridges are more likely to occur after age 40. The thumb and index fingernails are often most affected.
Injuries to the nail bed or cuticle can disrupt nail growth and lead to ridging. Common examples include slamming a fingernail in a door, hitting a thumb with a hammer, or other acute trauma to the nail.
The damaged section of nail will keep growing out with ridges until it fully grows past the nail tip, which takes 4-6 months for fingernails.
Several nail conditions are associated with longitudinal ridging:
Psoriasis - Pitting, ridges and other nail changes affect up to 50% of people with psoriasis due to associated inflammation and nail matrix changes.
Lichen planus - An inflammatory skin condition that can affect nails. Causes thinning and longitudinal ridges.
Alopecia areata - This autoimmune condition causing hair loss is linked to more than 10% of cases also having nail changes like pitting and ridging.
There are a range of vitamins, minerals and nutrients that help support healthy nail growth and development. Deficiencies in any of these can potentially contribute to nail abnormalities like longitudinal ridges:
Essential fatty acids
Those at higher risk for deficiency include vegans, vegetarians, elderly, dieters, or those with malnutrition from digestive disorders.
Both excess and insufficient thyroid hormone levels can impair nail development and cause ridging, brittleness, chipping or cracking.
This is thought to be related to changes in keratin formation affecting nail plate thickness and smoothness. Thyroid hormone imbalance also affects collagen production.
Poor blood sugar control in diabetics is linked to various nail changes. This is likely due to glycosylation - the unhealthy binding of glucose to body tissues. Circulation issues may also play a role.
However, many diabetics never develop nail problems. When present, ridging, discoloration, brittleness and thickness are often seen.
Certain medications like retinoids, beta blockers, and chemotherapy drugs can occasional cause nail ridging as a side effect. Discontinuation of the medication typically resolves this.
When to See a Doctor About Nail Ridging
Not all nail ridges are a cause for concern. Many cases are just a harmless sign of aging.
However, it is a good idea to point out worrisome nail changes to your doctor to determine if any evaluation is needed. See a doctor promptly if the ridging is accompanied by:
Sudden, rapid worsening of ridges over weeks
Discoloration - white, yellow, black streaks
Pitting, crumbling or thickening of nails
Nail separation from the bed
Pain, tenderness, bleeding around nails
Swelling or infection of nail folds
Family history of autoimmune disease
Yellow nail discoloration with ridging may indicate a fungal infection. Black streaks could be melanoma. White spots can result from past injury.
Sudden onset of multiple nail changes could signal a new systemic disease like thyroid disorder, diabetes, psoriasis or other autoimmune conditions.
Prompt diagnosis of the underlying cause is needed to prevent permanent nail damage in some cases.
How are Longitudinal Ridges Treated and Managed?
If the nail ridges are just an age-related change and not worrisome, no specific treatment is required. However, there are some tips to improve the appearance of stubborn ridges:
Massage nail oil or moisturizer into the nails and cuticles daily to nourish the nails. File ridges gently with an emery board in the direction of nail growth.
Avoid trauma to the nails that can worsen ridges. Wear gloves for gardening, housework.
Consider taking biotin supplements to improve nail strength.
Eat a balanced diet with adequate protein, vitamins and minerals for healthy nail growth.
For ridging related to a medical disorder, addressing the underlying condition is key:
Treating psoriasis, lichen planus, eczema with topical medications can resolve associated nail changes.
Levothyroxine medication for hypo/hyperthyroidism helps reverse related nail abnormalities.
Improving diabetes management and blood circulation aids in normalized nail growth.
Nutritional deficiencies are corrected through diet changes or supplementation.
In most cases, the longitudinal ridges tend to persist despite treatment efforts, but their appearance can be minimized with diligent care. Acrylic or gel nail overlays are also an option for concealing ridges.
Takeaways: Should You Worry About Longitudinal Ridging?
Longitudinal nail ridges are very common, affecting up to 25% of older adults.
They run vertically along the nail, parallel to the direction of nail growth.
Ridging is often just a sign of natural aging, but can also result from trauma, medical disorders or nutritional deficiency.
See a doctor if ridges seem to rapidly worsen or are accompanied by other nail changes like discoloration, pitting or crumbling.
Address any underlying conditions found, but improvement may be limited.
With proper nail care, the appearance of ridges can be minimized in most cases.
In summary, longitudinal ridging itself is harmless in most people. But pronounced, spreading or unusual-looking ridges warrant an evaluation to rule out other issues with the nails or systemic health. Working with your doctor to identify any causes and implementing a nail care routine can help reduce the unsightly look of nail ridges over time.