Nail psoriasis causes changes to the fingernails and toenails that can range from discoloration to alterations in the nail bed.

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The condition can have a physical and emotional impact on a person and affect their quality of life. It can take time for symptoms to improve, but treatment is available.

A study published in 2016 noted that 80–90% of people with psoriasis may also have nail psoriasis. It is even more prevalent in people with psoriatic arthritis.

This article will discuss nail psoriasis in more detail, including its causes, symptoms, and treatments.

Usually, skin cells reproduce every 28–30 days. People with psoriasis have an overactive immune system, which causes these cells to reproduce every 3–4 days. As a result, some visible skin sections are thick, inflamed, and itchy.

Nails are part of the skin. They grow from the nail root just under the cuticle, where psoriasis affects them. Nail psoriasis is a chronic condition of the immune system. It is an autoimmune condition, meaning the immune system mistakenly attacks the healthy nail tissue.

A person with nail psoriasis may have the following problems with their nails:

If the nail becomes detached from the nail bed, an infection can develop in the gap. When this happens, a yellowish patch may form on the tip of the nail and extend to the cuticle.

A chalky substance may develop under the nail, also creating a gap. This condition is known as subungual hyperkeratosis.

The nail may feel uncomfortable or painful when a person applies pressure, and an affected toenail may hurt when wearing shoes. The condition can make it difficult to perform specific tasks, such as sewing.

There is currently no cure for nail psoriasis. However, many treatment options are available.

  • Over-the-counter creams and ointments: These medications include corticosteroids such as hydrocortisone. A person may also try aloe vera, jojoba, zinc pyrithione, capsaicin, or salicylic acid with coal tar.
  • Prescription creams and ointments: Combinations of the local medications calcipotriene, tazarotene (Tazorac), and tacrolimus (Protopic) may be effective in improving mild cases.
  • Medications that affect the whole body: These are called systemic medications and require a prescription. Doctors usually reserve them for more severe cases, and it can take a long time for the nails to improve visibly. Examples of these medications include methotrexate, cyclosporine (Neoral), acitretin (Neotigason), and apremilast (Otezla).
  • Biologic drugs: A new class of drugs called biologics is proving useful in treating various conditions, including nail psoriasis. These artificially manufactured medications zero in on parts of the immune system that trigger inflammation. Examples include etanercept (Enbrel), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx), and abatacept (Orencia).
  • Corticosteroid injections: Intralesional therapy involves a doctor injecting medication into the nail bed. This produces positive results in some people, primarily when used alongside topical treatments. The doctor may use a numbing agent such as a local anesthetic to minimize the pain of the injection.
  • Removing the nail: If necessary, a doctor may decide to remove the nail with surgery or X-ray therapy or to apply a high concentration of urea in the area. The nail may still have an unusual appearance when it grows back. If infected nails are painful, a doctor may prescribe painkillers.
  • Non-drug treatments: Some people try phototherapy or laser therapy. However, there is little evidence that these work and researchers do not recommend them as first-line treatments. Laser treatment phototherapy can be painful and involves ultraviolet A wavelengths that may increase the risk of skin cancer.

Fungal infection

According to the National Psoriasis Foundation, around one-third of people with nail psoriasis also have a fungal infection.

A fungal infection affects the already formed part of the nail. Nail psoriasis causes issues in the area where the new nail is forming.

Because topical medications for psoriasis may never reach this area, doctors may prescribe oral medications instead. A doctor can prescribe medications to treat both psoriasis and a fungal infection at the same time.

If a person also has a fungal infection, their doctor may prescribe terbinafine (Lamisil) or itraconazole (Sporanox). However, these drugs can have adverse side effects, ranging from a skin rash to liver damage.

Certain nail care measures may help relieve symptoms and prevent the area from becoming infected.

For example, while working with the hands, it is a good idea to wear rubber or cotton gloves. This can protect the hands from injury and the fingers from harmful bacteria. It can also help protect the nails from corrosive materials such as cleaning agents. However, a person should avoid latex gloves, which can irritate sensitive skin.

The American Academy of Dermatology Association (AAD) recommends that a person with nail psoriasis keep their toe- and fingernails trimmed and clean to prevent bacteria from building up and refrain from cleaning the nails with a sharp object. If having a manicure, a person should request the manicurist not to push back or touch the cuticles.

As much as possible, a person should avoid biting or picking their nails or the surrounding skin.

Rubbing moisturizers into the nail and cuticle helps to keep the nails soft. A pharmacist or healthcare professional can advise about suitable products that prevent the hands, feet, and nails from becoming too dry. A thick, fragrance-free product is best.

Nail psoriasis is not contagious. Treatment can reduce or help control the symptoms.

If the nails show symptoms of psoriasis or fungal infection, a person should contact their doctor. This is especially important for people who already have a type of psoriasis.

A person may have to try several treatments before finding one that works. Symptoms can take time to improve and may take up to a year to clear. One reason for this is that the nail plate grows very slowly. The symptoms may also return at a later date.

With new drugs appearing on the market, more effective treatments for nail psoriasis may be on the horizon.

There is currently no cure for psoriasis. Anything that irritates the skin can cause the condition to flare up. The AAD offers the following advice to avoid flare-ups whenever possible:

Below are answers to some commonly asked questions about nail psoriasis.

Can I hide nail psoriasis?

If a person wants to hide the effects of nail psoriasis, they should talk with their dermatologist about the best options. Sometimes using nail polish or having a professional manicure might help, though a person should take care not to touch the cuticles and tell their nail technician about their condition. Certain types of nail polish and nail polish remover for people with sensitive skin do not contain the harsh chemicals that regular products do.

Does nail psoriasis spread?

Unlike a fungal infection, nail psoriasis does not spread through contact. Without treatment, nail psoriasis may get worse. In severe cases, it may become difficult for a person to use their hands or feet because of the discomfort of nail damage. Untreated, it can also lead to joint problems.

Is there a cure for nail psoriasis?

There is currently no cure for nail psoriasis. However, many treatment options may make the condition more comfortable. Even if a person’s nail psoriasis is severe, there are many ways to avoid or manage flare-ups. Symptoms may take up to a year to clear.

How does nail psoriasis look on skin of color?

People of Color with nail psoriasis may develop what looks like small pinpricks on the nail. The nails may also become thicker, crumble, and develop discoloration. Nail psoriasis can mimic other conditions. Often, a doctor may need to do a biopsy to identify nail psoriasis over other causes.

Nail psoriasis does not always cause physical pain but may cause embarrassment. Doctors often use a scoring system to help determine the severity of symptoms. Treatment can prevent the condition from worsening.

Nail psoriasis can resemble a fungal infection, making diagnosis difficult. Getting a correct diagnosis is vital because the treatment for a fungal infection is different from nail psoriasis treatment. Anyone with psoriasis who experiences changes in their nails should make sure their doctor is aware of their psoriasis.

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