Approach to Nail Pitting in Pediatric and Adolescent Patients: A Dermatology Perspective

ABSTRACT This narrative review aims to discuss the etiologies of nail pitting in pediatric and adolescent patients, while providing a framework for further evaluation of possible underlying systemic conditions and their clinical findings from a dermatologic standpoint. PubMed and Google Scholar searches were conducted using various Boolean search strings of relevant terms, complemented by hand‐searching the reference lists of key articles. Most cases of nail pitting in children are idiopathic. Disease‐associated nail pitting is most prevalent in psoriasis and juvenile psoriatic arthritis, juvenile idiopathic arthritis, alopecia areata, atopic dermatitis, and less commonly lichen planus. Several other conditions have been reported in association with nail pitting with weaker evidence. Causes other than systemic inflammatory diseases include chemotherapy, cosmetic nail products, other exogenous trauma to the nail matrix, as well as mimickers from direct trauma to nail plate.