Psoriatic arthritis (PsA) is a type of arthritis that commonly develops in people with psoriasis. Psoriasis is an inflammatory condition that leads to a rapid buildup of skin cells. These cells form patches of itchy skin that doctors call plaques.

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Both psoriasis and PsA commonly cause changes in the nails. However, PsA does not present the same way in everyone, and symptoms can vary from person to person.

This article discusses how PsA may affect the nails and some medical and at-home treatment options to try.

People with PsA commonly experience changes in their nails. In fact, researchers suggest that around 80% of people with PsA experience nail symptoms.

Many people may notice changes in their nails as an early symptom of PsA. Changes may affect any part of the nail structure and areas surrounding the fingers, including:

  • the visible part of the nail, which doctors call the nail plate
  • the nail bed, which is the skin beneath the nail
  • the nail matrix, which is the tissue at the bottom of the nail
  • the area where the nail meets the fingertip, called the hyponychium
  • the small, pale semicircle at the base of the nail, called the lunula

PsA can cause many visible symptoms in the nails. Some changes to look for include:

  • Pitting: Pitting is the most common nail symptom of PsA. It affects about 68% of people with psoriasis and causes the nail surface to look uneven. In some cases, random indents also appear in the nail.
  • Pink or oily patches: The skin underneath the nail may develop discolored pink patches. The nail may also appear to have trapped oil underneath it. The area can turn golden yellow or brown.
  • White spots: White discoloration on the nail may be a symptom of damage from psoriasis or PsA in the nail matrix.
  • Onychorrhexis or brittle nails: The nails may become very brittle. They may be more prone to breaking or crumbling. In some cases, the nails may even form large ridges or split at the ends.
  • Onycholysis: Onycholysis occurs when the nails lift or start to separate from the nail bed. A gap may form between the two, causing the nail to turn white or yellowish. As the gap extends down toward the cuticle, the nail may be prone to infection.
  • Hyperkeratosis: Psoriasis may cause a buildup of gray keratin cells under the nail.
  • Splinter hemorrhages: These are tiny blood spots that appear under the nail. Damaged capillaries in the nail bed can burst and release small amounts of blood that spread.
  • Fungal infections: Many people with nail changes due to psoriasis or PsA will also experience fungal infections of the nails, such as onychomycosis.

When do nail symptoms occur?

PsA may not present the same way for every person, but it typically always develops in stages.

In its preclinical stage, psoriatic inflammation may only cause fatigue, heel pain, and joint pain. At this time, doctors may not yet be able to identify the condition as PsA.

Once the condition progresses a little, nail changes can begin to occur. These include pitting, discoloration, softness, holes, and dactylitis, or the swelling of the toe or finger. This may still be an early phase of the condition.

As the condition progresses even further, these and other symptoms may get worse and progress to severe damage to the bones.

There is currently no cure for psoriasis or PsA, so treatment focuses on managing the symptoms and preventing further damage.

Treatments for nail problems due to PsA will focus on managing the underlying condition and relieving any pain. These treatments may include the following.

Topical creams

Medicated creams can help alleviate symptoms in the nail and nail bed. The type of medication in the cream can vary, depending on the problem.

For instance, some creams contain medications to slow the growth of cells, which may help with hyperkeratosis. Other creams can include steroids to reduce inflammation and damage.

A doctor might also recommend applying topical vitamin D cream.

Steroid injections

If a person has PsA with nail symptoms, a doctor may recommend injecting any affected joints with corticosteroids to help relieve inflammation. However, these injections are often not the first-line treatment.

When a doctor uses them to treat nail symptoms, these injections can be painful. Also, the surrounding nail or matrix may become weak after a person stops receiving the injections.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain from PsA, but they may not improve nail symptoms.

Phototherapy

In some cases, shining UV rays on the nails may help slow the growth of skin cells and stop some symptoms from affecting the nails.

Doctors can carry out this procedure in a clinic, or they may recommend specialty equipment for an individual to use at home.

General PsA treatments

A number of medications may be able to reduce the severity and frequency of flare-ups by targeting the underlying condition rather than the symptoms. These medications include the following.

Biologic therapy

Guidelines from 2018/2019 recommend biologic medications as a first-line treatment for anyone with a new diagnosis of PsA.

Biologics can help reduce disease activity by targeting specific parts of the immune system. However, they can also have side effects, and they do not suit everyone.

A doctor will give these medications as an injection or as an infusion.

Oral small molecule drugs

People who cannot use biologics can often take medications called oral small molecule drugs, such as tofacitinib (Xeljanz) or apremilast (Otezla).

A person takes these by mouth.

Disease-modifying antirheumatic drugs

This group of drugs includes various medications that work throughout the body to reduce inflammation or suppress the immune system.

A person may take these by mouth or in the form of an injection.

Some home remedies may help alleviate the symptoms of PsA in the nails and fingers. These include the following.

Over-the-counter pain-relievers

NSAIDs may reduce inflammation and pain in the nails. Over-the-counter (OTC) drugs, such as ibuprofen (Advil) and naproxen (Aleve), may help some people find relief from symptoms.

Some OTC medicated creams may also help if the nails are at risk of infection. They typically include two main ingredients: salicylic acid and tar.

A person may wish to talk with a doctor before using any additional creams or medicated ointments on any nails that PsA has affected.

Exercise

Current guidelines recommend that people with PsA participate in low impact exercise, such as swimming, tai chi, or yoga.

The National Psoriasis Foundation recommends exercise as a way to reduce inflammation in the joints and help relieve some symptoms of PsA. Exercise may also help improve a person’s quality of life.

Any low impact exercise may help a person with PsA manage their condition.

Diet

People who have PsA may have a variety of symptoms in addition to those that affect their nails, skin, or bones. The condition is closely related to psoriasis and may affect multiple systems in the body.

There is research indicating that psoriatic inflammation may make people more prone to health problems such as heart disease or obesity. Eating a healthy diet may help reduce this risk and help reduce inflammation that affects the nails.

People may wish to consider eating an anti-inflammatory or Mediterranean diet focused on fish, vegetables, and olive oil. In addition, they may wish to avoid processed foods as much as possible.

Nail care

General nail care is essential for people with PsA. Sustaining new injuries to the nail may trigger a symptom flare-up, so people should try to avoid activities that may damage their hands or nails.

Be sure to follow a doctor or dermatologist’s instructions on how to care for the nails each day. This may include carefully washing underneath the nail each day and keeping the nails short to prevent breaks.

Some other nail care tips include:

  • moisturizing the hands and feet with a natural, fragrance-free moisturizer
  • refraining from soaking the nails in hot water, as this may cause dryness and make symptoms worse
  • wearing gloves when working with the hands, including while washing dishes or working in the garden
  • avoiding chemicals in soaps, nail polishes, and fragrances, unless one is certain that they cause no reaction
  • avoiding manicures and pedicures, unless they are done in a sanitary environment that is free from harsh chemicals
  • resisting the urge to bite one’s nails

Anyone with PsA who is experiencing new nail symptoms may wish to contact a doctor. Likewise, anyone who is unsure about whether their treatment is working can ask a doctor about other treatment options.

The nails grow slowly, so results from any treatment can take time to show up. It is vital to be patient with one’s treatment regimen and to report any positive or negative changes to a doctor for review.

By working directly with a doctor, many people find relief from PsA in the nails.

PsA can affect the nails in a variety of ways. For example, the condition can cause pitting, discoloration, and brittleness. Also, the more severe the condition, the more severe its impact on the nails may be.

Although there is currently no cure for PsA, people can try a number of medical and natural treatments to help them manage the condition and reduce flare-ups.