Alopecia Areata Nails: Images, Symptoms, and Treatment

Alopecia areata is an autoimmune condition that causes abnormal inflammation around hair follicles, leading to excessive hair loss. The condition may cause nail symptoms, including texture, shape, or color changes.

These changes are usually minor and may not affect your daily life. However, some people have more serious nail changes that can cause pain and interfere with daily activities. 

About 45% of people with alopecia areata experience nail changes, and some changes are more common than others.

The number of nails with symptoms can vary, from one nail to all your nails being affected. The changes can affect your toenails or fingernails. The severity to which each nail is affected could differ, and you might see more than one type of nail change.

The changes can be subtle enough that you might not notice them. For some people, however, they may be apparent enough that they feel self-conscious.

In a minority of people, nail issues can cause nail crumbling and pain, making it difficult to do everyday tasks. If that’s the case, your nail problems might cause you more distress than your hair loss.

Nail Pitting

Pitting is the most common nail issue in alopecia areata, occurring in about 70% of people with nail changes. It looks like shallow indentations in the nails and usually affects only the fingernails, not toenails. 

Most often, nail pitting is mild and might not even be noticed. When severe, nail pitting might cause some nail crumbling and nail pain, which might interfere with your normal activities.

Trachyonychia

The word trachyonychia has Greek origins, roughly translating to “rough nails.” It affects about a quarter of people with nail changes from alopecia areata.

With trachyonychia, the nails are rough, brittle, thin, and fragile, often affecting all 20 of your nails. You might see longitudinal ridging, where multiple ridges run up the length of your nail. The nails may appear extra shiny, and you may also see nail splitting, cracks in the nail that can cause pain.

Leukonychia

Leukonychia comes from the Greek word for “white nails.” It may affect around 20% of people who have nail issues from alopecia areata. In leukonychia, small white spots are distributed across the nails. The condition doesn’t usually cause pain.

Other Nail Changes

Other nail changes, such as excessive brittleness and thinness, might lead to further nail damage. Ragged cuticles or brown discoloration might also occur with alopecia areata.

Some other possible but uncommon issues can include:

• Red lunula: Reddish patches in the white, crescent-shaped area at the base of the fingernail, seen especially in people with very severe alopecia areata
• Beau’s lines: Dents that run across the nails horizontally
• Koilonychia: An indented “spoon-like” shape to the nails
• Onycholysis: When the nail separates from the underlying nail bed

Onycholysis is very rare, but it probably impairs day-to-day activities and requires direct treatment more often than other nail changes.

In alopecia areata, parts of your immune system become abnormally activated. Lymphocyte cells may target areas around the hair follicles, leading to hair loss. 

Nails share similarities in structure to hair follicles. Because of that, some inflammatory cells that affect hair follicles may also affect the nails of certain people with alopecia areata.

Nail changes from alopecia areata sometimes occur before experiencing hair loss or being diagnosed with alopecia areata. Other times, your nails might show changes months to years after your initial hair loss. Most often, they start at roughly the same time.

The specific type of nail change may not influence the treatment, but the nails’ overall severity—how many nails are affected, whether you are in pain, and how your everyday activities are impacted—can dictate treatment.

Many people don’t need specific treatment for nail symptoms, particularly if the changes aren’t severe. Nails often improve with standard oral treatments for alopecia areata, such as oral corticosteroids or drugs like Olumiant (baricitinib).

Some nail changes improve even without treatment, especially in children.

People with more significant nail issues might need medications applied directly to the nail and nearby skin. Options might include vitamin A-based creams like Tazorac (tazarotene) or corticosteroids like Clobex (clobetasol). Corticosteroids can also be injected right into the nail.

A cream made with urea may help people with nail plate separation. Additionally, if you aren’t yet taking an oral medication such as Olumiant, you could consider starting one.

Approaches Other Than Medications

Nonpharmacological approaches can also be helpful for nail issues. Ointments like petroleum jelly can help trap moisture in the nail, while nail polish can help hide certain nail problems. 

It’s also important to prevent nail trauma by doing the following:

• Trim your nails regularly
• Prevent excess exposure to water, as this can weaken brittle nails
• Avoid biting or picking your nails
• Limit the use of your nails as tools

If you have more severe hair loss, nail changes are more likely to happen. For example, people with hair loss patches from alopecia areata are much less likely to have nail symptoms than people with more widespread hair loss.

Children are also more likely than adults to have symptoms related to their nails.

If you have alopecia areata and your nail changes are bothering you, bring it up with a healthcare provider. This is especially important if your nails are causing you pain and interfering with your life.

A dermatologist may already be helping you manage your alopecia areata. Dermatologists are doctors trained in conditions that affect the skin, hair, and nails, making them a helpful provider for alopecia areata-related nail issues.

People with alopecia areata—especially those with more severe hair loss—may experience nail changes, ranging from mild cosmetic issues to more significant problems causing pain.

Standard treatments for alopecia areata can help with nail changes, but work with your healthcare provider if your symptoms bother you or interfere with your daily life.