How does psoriatic arthritis affect the nails?
In this article, learn about how psoriatic arthritis affects the nails, as well as about medical and at-home treatment options.
Psoriatic arthritis and the nails
Nail changes due to psoriatic arthritis are very common.
Researchers have found that 80 to 90 percent of people with plaque psoriasis experience changes in their nails, and that nail changes are even more widespread in those with psoriatic arthritis.
Many people may notice changes in their nails as an early warning sign of psoriatic arthritis or damage to the joints.
Changes may appear in any part of the nail structure or surrounding finger or thumb, including:
- the visible part of the nail that doctor 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 (hyponychium)
- the small, pale semi-circle at the base of the nail (lunula)
Image credit: Seenms, 2011.
Image credit: CopperKettle, 2012.
Image credit: Splarka, 2010.
Image credit: Dandandandandandandan2014, 2014.
Signs and symptoms
Psoriatic arthritis may cause many visible signs and symptoms in the nails. Signs to look out for include:
Pitting: Pitting is the most common nail symptom, affecting about 68 percent of people with psoriasis and nail changes. The nail surface may look uneven. In some cases, random indents appear in the nail.
Pink or oily patches: The skin underneath the nail may develop discolored, pink patches. The nail may 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 sign of damage from psoriasis or psoriatic arthritis 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 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 towards the cuticle, the nail may be prone to infection.
Hyperkeratosis: Psoriasis may cause a buildup of grey 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 psoriatic arthritis will also experience fungal infections of the nails, such as onychomycosis.
Applying medicated creams may help alleviate symptoms in the nails and nail bed.
There is no cure for psoriasis or psoriatic arthritis, so treatment focuses on managing symptoms and preventing further damage.
Treatments for nail problems due to psoriatic arthritis will focus on managing the underlying condition and relieving any pain. These treatments may include:
Medicated creams may help alleviate symptoms in the nails and nail bed. The type of medication in the cream can vary, depending on the problem.
For instance, some creams have medication 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.
If a person has psoriatic arthritis with nail symptoms, a doctor may recommend injecting any affected joints with corticosteroids to help relieve inflammation.
When a doctor uses them to treat nail symptoms, these injections can be painful. They are often not the first-line treatment. Also, the surrounding nail or matrix may become weak after a person stops receiving the injections.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
These can help reduce inflammation and pain from psoriatic arthritis but may not improve nail symptoms.
In some cases, shining UV rays on the nails may help slow the growth of skin cells and stop some symptoms appearing in the nails. Doctors can carry out the procedure in a clinic or may recommend specialty equipment for the individual to use at home.
General psoriatic arthritis treatments
A number of long-term treatments can reduce the severity and frequency of flares by targeting the underlying disease rather than the symptoms.
Biologic therapy: Guidelines published in 2019 recommend biologic medications as a first-line treatment for anyone with a new diagnosis of psoriatic arthritis. Biologics can help reduce disease activity by targeting specific parts of the immune system. However, they can also have side effects and do not suit everyone. A doctor will give these as an injection or infusion.
Oral small molecule drugs: People who cannot use biologics can often take a type of drug called oral small molecules, such as tofacitinib (Xeljanz) or apremilast (Otezla). A person takes these by mouth.
Disease-modifying antirheumatic drugs: This group includes various medications that work throughout the body to reduce inflammation or suppress the immune system. A person may take these as an injection or by mouth.
Some home remedies may help alleviate the symptoms of psoriatic arthritis in the nails and fingers. These include:
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.
People may want to talk to a doctor before using any additional creams or medicated ointments on any nails that psoriatic arthritis has affected.
The National Psoriasis Foundation recommend exercise as a way to reduce inflammation in the joints and help relieve some symptoms of psoriatic arthritis. Exercise may help improve a person's quality of life.
Any low-impact exercise may help a person with psoriatic arthritis manage their condition.
General nail care is essential for people with psoriatic arthritis. New injuries to the nail may trigger a symptom flare-up, so people should 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 practices such as carefully washing under the nail each day and keeping the nails short to avoid breaks.
Other tips to care for the nail during treatment include:
- moisturizing the hands and feet with a natural, fragrance-free moisturizer
- refraining from soaking the nails in hot water, as it may cause dryness and make symptoms worse
- wearing gloves whenever working with the hands, including while washing dishes or working in the garden
- avoiding chemicals in soap, nail polish, and fragrances unless certain they cause no reaction
- avoiding manicures and pedicures unless they are in a sanitary environment free from harsh chemicals
- resisting the tendency to bite the nails
When to see a doctor
Anyone with psoriatic arthritis who is experiencing new nail symptoms may wish to see a doctor. Likewise, anyone who is uncertain if their treatment is working can ask about other treatment options.
People's nails grow slowly, so results from any treatment can take time to show up. It is vital to be patient with treatment and report any positive or negative changes to a doctor for review.
By working directly with a medical professional, many people find relief from psoriatic arthritis in the nails.