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

Nail pitting in pediatric and adolescent patients can be a benign idiopathic condition or a sign of underlying systemic disorders such as trachyonychia, psoriasis, alopecia areata, and atopic dermatitis. The review emphasizes the importance of thorough clinical evaluation to identify potential underlying conditions and improve patient outcomes. In juvenile psoriatic arthritis, nail pitting is prevalent, with a study showing a 37.5% prevalence among 316 patients. In alopecia areata, nail pitting is more common in children, with a prevalence of 73.9% in a study of 197 patients under 18. Nail pitting in atopic dermatitis correlates with disease severity, with a 26% prevalence in pediatric patients. The study calls for more research on subtype-specific associations and highlights the importance of personal and family history, careful examination, and potential dermoscopy. Treatment focuses on addressing the underlying disease, with idiopathic cases often resolving spontaneously. Regular follow-up and early referral are recommended if nail pitting is discovered outside of dermatology.