Ridged Nails (Onychorrhexis)
Ridged nails are a common nail concern that can range from a normal part of aging to a sign of an underlying nail disorder. Because nail ridging may be caused by trauma, inflammatory skin diseases, nutritional deficiencies, or damage to the nail matrix, an accurate diagnosis is essential. Through a virtual nail consultation, Dr. Dana Stern can identify the underlying cause of your ridged nails and develop a personalized treatment plan to restore healthy nail growth.
What is Onychorrhexis?
Nail ridges are raised lines or grooves that develop on the nail plate. They may run lengthwise from the cuticle to the tip of the nail (longitudinal ridges) or across the nail from side to side (horizontal ridges, also known as Beau’s lines). The direction, appearance, and number of ridges often provide important clues to the underlying cause. Longitudinal ridging becomes increasingly common with age and is often a normal finding. However, prominent ridges may also result from trauma, inflammatory nail diseases, chronic eczema, lichen planus, or other disorders affecting the nail matrix. Horizontal ridges are less common and often reflect a temporary interruption of nail growth caused by illness, injury, or significant physiologic stress.
What Causes Nail Ridges?
Ridged nails develop when the nail matrix, the part of the nail responsible for producing the nail plate, is disrupted. The underlying cause depends on the direction and pattern of the ridges. Common causes include:
Normal aging
Hormonal shifts
Repeated trauma to the nail matrix
Nail biting or nail picking
Nail psoriasis
Nail eczema
Nail lichen planus
Nutritional deficiencies (less commonly)
Significant illness causing temporary interruption of nail growth
Certain medications
Inflammatory diseases affecting the nail matrix
Signs and symptoms of Nail Ridges
Ridged nails may affect one nail or multiple nails and can vary in severity. If you’re experiencing any of the following nail changes, an evaluation may be warranted.
Vertical (longitudinal) ridges
Horizontal ridges (Beau’s lines)
Rough nail surface
Splitting or cracking along the ridges
Brittle nails
Changes affecting one or several nails
Nail thinning or thickening
Nail discoloration
Progressive nail deformity
Nail changes associated with pain or inflammation
How Dr. Stern Evaluates Nail Ridges Virtually
For both asynchronous e-visit and live video consults, Dr. Dana Stern will review your photos and intake forms, prior treatments and your current medications and health history. For asynchronous e-visits, you will receive a detailed treatment plan to share with your local healthcare provider, including recommendations for additional evaluation when needed. For live video consultations, Dr. Stern can prescribe medications, order labs, and coordinate care with your local provider when needed.
Ridged Nail Treatment Options
Your treatment plan will depend on the underlying cause of your nail ridging and whether other nail disorders are present. Possible treatment approache:
Treatment of underlying inflammatory nail disease
Prescription topical medications when appropriate
Nail care recommendations
Strategies to minimize trauma to the nail matrix
Evaluation for nutritional deficiencies when indicated
Moisturizing and barrier repair recommendations
Monitoring nail growth over time
Local care coordination if additional evaluation is needed
Find The Right Next Steps For Ridged Nails
If your ridged nails have not improved despite moisturizers, supplements, nail strengtheners, or cosmetic treatments, Dr. Stern will carefully review your medical history and nail findings to determine the underlying cause. In many cases, persistent ridging is caused by an inflammatory nail disorder such as lichen planus rather than simply aging. Identifying and treating the underlying condition is the key to improving nail appearance and promoting healthy nail growth.
About Dr. Stern
Dr. Dana Stern is a board-certified dermatologist with more than 20 years of experience treating nail disorders. Her practice is devoted exclusively to nail health, and she is a nationally recognized expert, published author, and frequent speaker on nail disease. Recognized by Castle Connolly and Super Doctors and regularly featured in the media, Dr. Stern provides convenient, expert care through her specialized virtual nail consultation practice.
Start Your Virtual Nail Consultation
If you’re concerned about ridged nails, Dr. Stern can help determine whether they represent normal aging or an underlying nail disorder requiring treatment. Through a secure virtual consultation, you’ll receive an expert evaluation and a personalized plan designed to restore and preserve healthy nail growth.
New Patients
For patients who would like to begin care with Dr. Stern through a virtual nail consultation.
Current Patients
For established patients who need a follow up visit, medication review, treatment update, or ongoing nail care guidance.
Nail Ridging FAQ
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Yes. In many cases, Dr. Stern can determine the cause of nail ridging by reviewing your medical history, symptoms, and high-quality nail photographs. If additional testing is needed, she will explain exactly what is recommended.
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Longitudinal ridged nails (onychorrhexis) are a type of brittle nail.
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Yes, when nail trauma affects the nail matrix it can result in permanent ridges or other nail findings.
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Vertical ridges and horizontal ridges have very different causes. Expert evaluation can determine cause and the best treatment approach.
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Often, yes. Mild longitudinal ridging commonly develops with age. However, prominent, rapidly changing, painful, or irregular ridges may indicate an underlying nail disorder and should be evaluated.
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Yes. Improvement depends on the underlying cause. If an inflammatory nail disorder or another treatable condition is identified, appropriate treatment may improve the appearance of future nail growth.
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Not usually. Ridged nails are typically diagnosed based on the clinical examination and medical history. However, additional laboratory testing may be recommended if an underlying nutritional deficiency, fungal infection, or systemic condition is suspected.
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You will receive links to either your email or text that contain our demographic form, consent form, nail questionnaire and photo upload instructions. Our staff is always available to help should you have any questions or issues.