Overview

Nail Psoriasis

Nail psoriasis is a common condition where psoriasis, an autoimmune disease, affects your fingernails and toenails. It happens because your body's immune system mistakenly attacks healthy nail cells, causing them to grow too quickly and build up. Anyone can develop nail psoriasis, but it's most common in people who already have skin psoriasis; in fact, up to half of people with psoriasis will experience nail changes. Sometimes, nail psoriasis can be the very first sign of psoriasis. It is not contagious, so you can't catch it from or spread it to someone else. Living with nail psoriasis can be frustrating, as it can affect the appearance of your hands and feet, and sometimes cause discomfort.

2. Symptoms

You might notice a few different changes in your nails. Here are some common ones:

• Pitting: Small dents or pits on the surface of your nails, like the surface of a thimble.
• Discoloration: Your nails might turn a yellowish-brown color, or you might see oil-drop or salmon-pink patches under the nail.
• Nail separation (Onycholysis): The nail may lift away from the skin underneath (the nail bed), starting at the tip and moving towards the base. This can create a space where dirt and infection can collect.
• Thickening: Nails can become much thicker than usual, sometimes making them hard to trim.
• Crumbling: The nail might become brittle and start to crumble or break easily.
• Beau's lines: These are deep grooves or lines that run across the nail.
• Splinter hemorrhages: Tiny black or reddish-brown lines under the nails, looking like small splinters, caused by burst blood vessels.
• Redness of the lunula: The half-moon shaped area at the base of your nail (the lunula) might look red.

The severity of these symptoms can vary greatly from person to person, and sometimes they can be triggered or worsened by injury to the nail.

3. Diagnosis

A doctor, often a dermatologist, can usually diagnose nail psoriasis by carefully looking at your nails and skin. They will ask about your medical history and any family history of psoriasis. In some cases, if the diagnosis isn't clear, your doctor might take a small sample of your nail (a nail clipping or biopsy) to look at under a microscope. This can help rule out other conditions like fungal infections, which can sometimes look similar.

Management & Treatment

Dealing with nail psoriasis can be a journey, but please know that you're not alone and there are many ways to manage it. Finding the right approach can take time, as nails grow slowly, but with patience and consistent care, you can see improvement.

Treatments for nail psoriasis aim to clear the nail and improve its appearance. The best approach for you will depend on how severe your condition is and what other symptoms you might have.

Home Care & Self-Management

Good nail care is a cornerstone of managing nail psoriasis and can make a big difference.

• Keep nails short. Trim your fingernails and toenails regularly. This helps prevent them from lifting off the nail bed and reduces the buildup of debris underneath.
• Be gentle. Avoid aggressively cleaning under your nails, as this can worsen the separation (onycholysis) and increase the risk of infection. With proper treatment, this buildup will clear.
• Moisturize, moisturize, moisturize. Just like the skin on your hands, your nails and cuticles benefit from moisture. Apply a heavy cream or ointment daily, especially after your hands have been in water.
• Protect your hands. Wear gloves when doing dishes, cleaning, or any work that involves getting your hands wet or using harsh chemicals.
• Avoid nail trauma. Try not to bite your nails or pick at your cuticles. Any injury to the nail can trigger a flare-up.
• Cosmetic care is okay. It's perfectly fine to gently buff your nails to smooth out ridges or use nail polish to cover pits and discoloration. However, it's best to avoid artificial nails, as the application and removal process can be harsh and damage your natural nails.

Medical Treatments

If home care isn't enough, or if your nails are causing you pain and discomfort, it’s time to talk with a dermatologist. They have a range of treatments that can help.

• Topical Medications: For milder cases, your doctor might prescribe a medicated cream, ointment, or nail lacquer. These are applied directly to the nail and surrounding skin. Common options include corticosteroids, vitamin D-based treatments (like calcipotriol), or retinoids. Sometimes, a cream containing urea is used to help thin out very thick nails, allowing the medicine to penetrate better.
• Injections: For more stubborn nail changes, your dermatologist may suggest injecting a small amount of corticosteroid medication directly into the skin around the affected nails. While this can be very effective, it can also be uncomfortable.
• Light Therapy (Phototherapy): This treatment involves exposing the nails to controlled doses of ultraviolet (UV) light. It's usually done in a doctor's office and requires multiple sessions.
• Systemic Medications: If you have severe nail psoriasis, or if you also have moderate to severe skin psoriasis or psoriatic arthritis, your doctor may recommend a medication that works throughout your body. These can be pills (like methotrexate or apremilast) or injections (known as "biologics"). These powerful drugs target the underlying inflammation and can be very effective for both skin and nails, but they require careful monitoring by your doctor.

What to Expect

It's so important to have realistic expectations. Because your nails grow very slowly, it can take 6-12 months of consistent treatment to see a completely clear fingernail, and even longer for toenails. The goal is for the new nail that grows in to be healthier.

If one treatment doesn't seem to be working after a few months, don't lose hope. Treating nail psoriasis often requires trying a few different approaches to find the best fit for you. Open communication with your dermatologist is key to finding a plan that helps you feel and look better.

4. Duration & Outlook

Nail psoriasis is often a chronic condition, meaning it can last for a long time, sometimes for many years. You might experience periods where your nails improve (remission) and times when they get worse (flares).

While there's no cure for psoriasis itself, the changes to your nails can sometimes be managed. Without attention, severe nail psoriasis can sometimes lead to permanent nail changes or make daily tasks difficult. Warning signs for complications include significant pain, swelling, pus, or redness around the nail, which could signal an infection.

5. Prevention

While you can't always prevent nail psoriasis, especially if you have underlying skin psoriasis, there are things you can do to help protect your nails and potentially reduce flare-ups:

• Keep your nails short and trimmed. This helps prevent them from catching on things and lifting further.
• Protect your nails from injury. Wear gloves when doing manual work, washing dishes, or using cleaning products. Even minor injuries can trigger nail psoriasis.
• Keep your nails dry. Moisture can make some nail problems worse and increase the risk of fungal infections, which can complicate nail psoriasis.
• Avoid biting your nails or picking at your cuticles.
• If you have psoriasis, managing your overall condition as advised by your doctor may also help your nails.

6. Causes & Triggers

Nail psoriasis is caused by an overactive immune system, the same underlying cause as skin psoriasis. Your body's defense system mistakenly targets healthy nail cells, leading to rapid cell growth and the changes you see.

Common triggers that can worsen nail psoriasis or cause a flare-up include:

• Injury to the nail: Even minor bumps or cuts can trigger psoriasis in that area (this is called the Koebner phenomenon).
• Stress: Emotional stress is a known trigger for psoriasis in general, and this can extend to nail psoriasis.
• Infections: Certain infections can sometimes trigger or worsen psoriasis.

People who already have psoriasis elsewhere on their body are most likely to develop nail psoriasis. A family history of psoriasis also increases your risk.

7. When to see a doctor

It's a good idea to see a doctor or a dermatologist if:

• You notice any of the nail changes described, especially if you also have skin rashes or joint pain.
• Your nail changes are causing you pain, discomfort, or making it hard to use your hands or feet.
• You see signs of infection around your nails, such as redness, swelling, warmth, or pus.
• The appearance of your nails is causing you significant distress or affecting your self-esteem.
• Over-the-counter measures haven't helped, or your condition seems to be getting worse.

A dermatologist can provide an accurate diagnosis and discuss the best ways to care for your nails.

8. Frequently Asked Questions (FAQs):

• Q: Is nail psoriasis the same as a fungal nail infection? No, they are different, though they can sometimes look similar or even occur at the same time. Nail psoriasis is an autoimmune condition, while a fungal infection is caused by a fungus. A doctor can help tell the difference.
• Q: Can nail psoriasis affect only one nail? Yes, it's possible for nail psoriasis to affect just one nail, or several, or all of them. It can also affect fingernails, toenails, or both.
• Q: Will nail psoriasis go away on its own? Sometimes nail psoriasis can improve on its own, especially if it's mild. However, it's often a chronic condition that may come and go.
• Q: Can I wear nail polish if I have nail psoriasis? Generally, yes, you can wear nail polish. However, be gentle when applying and removing it. Avoid harsh chemicals in removers, and give your nails a break from polish occasionally. If your nails are very damaged or infected, it might be best to avoid polish until they improve.

I hope this information helps you understand nail psoriasis a little better. Please remember, if you're concerned about your nails, reaching out to a healthcare professional is always the best course of action. They are there to help you.

References

• American Academy of Dermatology. (n.d.). What is nail psoriasis, and how can I treat it?. Retrieved from https://www.aad.org/public/diseases/scaly-skin/psoriasis/diagnosis-and-treatment-of-psoriasis/what-is-nail-psoriasis-and-how-can-i-treat-it
• Cleveland Clinic. (2022, April 4). Nail Psoriasis: What It Is, Causes, Nail Pitting, Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/22841-nail-psoriasis
• National Psoriasis Foundation. (n.d.). Nail Psoriasis. Retrieved from https://www.psoriasis.org/hands-feet-nails/
• WebMD. (2023, August 29). Nail Psoriasis: Symptoms, Treatment, Prevention. Retrieved from https://www.webmd.com/skin-problems-and-treatments/psoriasis/nail-psoriasis