How Alopecia Areata Can Affect Your Nails

On average, about 20% to 30% of people with alopecia areata (an autoimmune disease that causes patchy hair loss) experience changes to their fingernails and toenails. If you notice alopecia areata nail changes, your healthcare provider can provide guidance on how to care for and treat your nails.

How does alopecia areata affect your nails?

When you have alopecia areata, your immune system can target structures at the root of the nail, leading to inflammation and nail changes like:

• Pitting
• Brittleness
• Ridges or splitting
• Roughness
• Small, white spots

Most of these nail changes don’t typically cause pain, says dermatologist Stephanie Trovato, MD. While they may happen after or at the same time as hair loss, they can also happen before you notice hair loss.

Alopecia areata universalis, which causes total hair loss on your scalp and body, is more likely to cause nail changes than other types of alopecia areata.

How to care for your nails

It’s important to keep your nails healthy. Dr. Trovato offers the following tips:

• Keep nails well-trimmed: If your fingernails or toenails get too long, they’re more likely to break.
• Use protective gloves: Whether you’re washing the dishes or have a job that involves submerging your hands in water, Dr. Trovato suggests wearing protective gloves to keep your hands and nails dry.
• Wear comfortable shoes: Opt for shoes that have room for your toes to move around. Avoid footwear that pinches your toes or is too tight.
• Eat a well-balanced diet: Eating healthy foods may help strengthen your nails, so follow a diet (such as the Mediterranean diet) that’s full of fruits, vegetables and protein.

Should you also consider adding a hair and nail growth supplement like a vitamin B complex, vitamin D, vitamin E or biotin?

“I recommend discussing with your primary care doctor or dermatologist to decide if supplements are needed,” advises Dr. Trovato.

Medical treatment for alopecia areata nail changes

Your healthcare provider may suggest the following treatment options:

• Topical steroids: Dr. Trovato says topical steroids are a common treatment for nail changes from alopecia areata. They’re available as a cream, ointment or foam that you can apply directly to your nails.
• Topical retinoids: In studies, options like tazarotene 0.1% gel have been shown to help with nail changes in people with alopecia areata.
• Intralesional injection steroids: This in-office treatment involves injecting medication into your nail matrix (the area under your nail beds).
• Janus kinase (JAK) inhibitors: JAK inhibitors are a class of medication typically used for people with severe alopecia areata who haven’t responded well to other treatments. “They work by targeting a specific pathway that leads to inflammation attacking the hair follicles,” Dr. Trovato explains. “By quieting this pathway, it reduces the immune attack on the hair follicle, allowing the hair cycle to be restored and leading to hair growth and reduction in nail changes associated with alopecia areata.”

After you start treatment, it may take a few months before you see new hair growth — and you may need to keep treating your nails even after your hair grows back, says Dr. Trovato.

When to see a doctor

If you notice hair loss or nail changes, see your healthcare provider, who can provide a diagnosis and offer treatment options.

“If your nail changes are bothersome or concerning, don’t hesitate to see your doctor,” Dr. Trovato stresses.