Definition, treatment, and home remedies

Nail psoriasis causes changes to the fingernails and toenails, ranging from discoloration to alterations in the nail bed. There are various treatment options, such as hydrocortisone cream and corticosteroid injections.

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:

• dents or holes
• white spots
• grooves
• changes in shape or size
• thickening
• onycholysis, separation of the nail from the nail bed
• crumbling
• discoloration
• blood streaks

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:

• protect the skin from sunburn
• use a cold compress
• moisturize regularly
• avoid scratching
• avoid stress
• avoid skin injuries such as cuts and bug bites

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.

Read this article in Spanish.

Nail Psoriasis: You Can’t Cure Nail Psoriasis, But These Treatment Options Might Help

We all have those moments where we find ourselves self-consciously hiding our nails. Maybe it’s because they’re nibbled or nicked, or in desperate need of a good cuticle taming. Luckily, in most cases it’s easy enough to hide less-than-pretty nails. We keep our hands in our lap during a work meeting, blur our nails in Instagram closeups, and regularly thank whoever invented pockets and started putting them in dresses and skirts too. If you’re someone with nail psoriasis, though, feelings of nail-consciousness can become nonstop—and start to seriously impact your quality of life.

What is nail psoriasis?

This condition involves nail changes that can become difficult to ignore or cover up, even with a fresh manicure: fingernails or toenails that are pitting, grooved, rough, thickened, or even crumbling. Other common signs of nail psoriasis include discoloration of the nail plate and/or nail bed, super-skinny streaks of blood under the nail plate (google “splinter hemorrhage” for a helpful visual), nails that are separating from the nail bed (known as onycholysis) and red spots on the lunula, that little half-moon at the base of your nails. (Who knew it had such a cute name?) You might also experience something called subungual hyperkeratosis, where chalky skin constantly builds up under your nail. Aesthetic and psychological concerns aside, nail psoriasis can also become physically uncomfortable and even painful to live with—on a whole other level than when a toe hangnail catches on your sheets.

So what causes nail psoriasis, exactly?

Like plaque psoriasis—the most common form of psoriasis, which produces rough, thick patches of skin on various parts of the body—nail psoriasis is a chronic inflammatory condition that has some genetic links and environmental triggers and isn’t curable, but thankfully is treatable. The two conditions usually go hand in hand: Nail psoriasis typically appears after moderate to severe psoriasis has already cropped up elsewhere on the body, and its prevalence among people with a psoriasis diagnosis is high—about half of the people with plaque psoriasis and 80% of people with psoriatic arthritis (a type of psoriasis involving joint pain/stiffness) do experience some nail involvement. That said, it’s possible to experience nail psoriasis without having any other symptoms of skin disease.

How is nail psoriasis diagnosed?

Treatment of nail psoriasis begins with a visit to a dermatologist, who will perform an exam to confirm the diagnosis—rarely, this may involve a nail biopsy—and rule out other conditions that can prompt similar nail changes, like a fungal infection (onychomycosis).

How do you treat nail psoriasis?

Your dermatologist will then prescribe a treatment, which can be local and topical, systemic, or sometimes a combination. One important thing to keep in mind about treatment of nail psoriasis is that more often than not, it takes some trial and error to find the combination of medications that works for you, so don’t get frustrated if you don’t see results on the first go-round. If your nail psoriasis symptoms are mild (according to the nail psoriasis severity index) and/or just a few nails are affected, your dermatologist may first prescribe a topical steroid or retinoid treatment (such as tazarotene) that you apply once or twice a day. There’s also evidence that massaging a vitamin D cream or ointment into the cuticles for five minutes twice a day can help ease the symptoms of nail psoriasis.

If your nail psoriasis is stubborn or more severe, or if you also have plaque psoriasis symptoms elsewhere on your body or experience symptoms of psoriatic arthritis, such as joint pain and stiffness, you’ll likely also be prescribed a systemic treatment that targets inflammation throughout your body; these can include corticosteroids, drugs like methotrexate, or biologic therapies. Other treatment options include intralesional injections of medication under your nails, laser treatments, or phototherapy, where you expose the affected areas to regular, targeted doses of ultraviolet light in a dermatologist’s office.

When treating nail psoriasis, patience is key: Because nails grow slowly and create a barrier that makes it difficult for medications to penetrate, it can take several months for treatment to take effect and up to a year to see your nails get fully back to normal—even when using systemic therapies.  It’s important to stick with your treatment plan, since not treating psoriasis of the nails can lead to complications like nail loss or even trouble using your hands and feet.

Are there any home remedies or tips for the symptoms of nail psoriasis?

In the meantime, practicing some good nail care habits recommended by the National Psoriasis Foundation can help keep nail psoriasis from getting worse. These include keeping your nails short, wearing gloves when you’re doing yard work or cleaning, and using hand cream every time you wash your hands or shower. You should also avoid biting, cutting, or pushing your cuticles, and digging under your nail tips to clean them, since all of the above can lead to infections that can make your nail psoriasis flare up. And while buffing and painting nails can be a great way to camouflage nail psoriasis, it’s best to avoid gel or acrylic nails, which can cause irritation and also increase the risk of your nail separating from your finger.  One more factor to keep in mind is that while phototherapy can be helpful in treating psoriasis within a dermatology office, exposure to the sun can often exacerbate nail psoriasis, so putting sunscreen on your hands regularly (to coat any affected skin around or under your nails) is a smart habit to adopt. 

Nail psoriasis – health articles

Nail lesions may be the only sign of psoriasis, but in most cases it appears at the same time as the skin disease.

One, several or all nails can be changed. Total nail damage occurs in patients with a long and more severe course of the disease, the presence of psoriatic arthritis, early onset of psoriasis, and in patients with a burdened family history.

Signs of nail psoriasis

Let’s see what criteria can be used to suspect psoriasis of the nails:

• The formation of small depressions on the nail plate, the so-called thimble symptom. Several or many small pits appear in random order or in groups along the longitudinal lines, and sometimes crosswise, resembling the outer surface of a thimble
• Onycholysis is the painless separation of the nail from the nail bed without any previous inflammation. The subungual space is gradually formed, where dust, exfoliating epidermis, as well as air bubbles accumulate, the nail has a yellow color. Onycholysis is often mistaken for a fungal infection
• Oil spot symptom: yellow-brown spots that are visible through the surface of the nail
• Longitudinal hemorrhages (in the form of a splinter) – point and strip-like hemorrhages of dark red, and then black, they occur as a result of rupture of dilated and blood-filled capillaries
• Leukonychia – the appearance of dotted, streak-like or extensive solid white areas on the nails
• Nail failure – brittle plate crumbles
• Red spots in the area of ​​the nail hole
• Transverse furrows (Bo lines)
• Longitudinal combs
• Onychomadesis – rejection at the base of the nail
• Onychorrhexis – longitudinal splitting

Diagnosis, as you can see, is not easy. Often a secondary infection joins. In this case, you need to contact a dermatovenereologist and pass a series of tests, such as microscopic examination for pathogenic fungi, inoculation for mycelium-forming fungi, inoculation for fungi of the genus Candida, a blood test.

The doctor makes a diagnosis based on several symptoms, examining the patient completely.

Methods of treatment

After assessing the severity of the psoriatic process, treatment is prescribed. The method of therapy is selected individually, taking into account all the characteristics of the patient. Treatment includes:

• Proper home nail care
• Vitamin and micronutrient supplementation
• Topical application of ointments and creams that help relieve swelling and itching
• Physiotherapy treatment. With its help, the growth and division of cells slows down, which underlies psoriasis. More commonly used ultraviolet radiation (phototherapy (PUVA)
• Treatment of the skin process of psoriasis with systemic drugs such as cyclosporine, methotrexate or acitretin often improves the condition of the nails
• Biological therapy is also actively practiced now, which gives very good results in a short period of time

The main conclusion is that the lack of professional treatment threatens with complications that can result in the spread of the process throughout the body.

Therefore, you need to contact specialists in time to achieve a stable improvement in the condition of nails and skin.

Do not delay treatment, see a doctor right now:

• Treatment of psoriasis and dermatitis with PUVA therapy
• Appointment with a dermatovenereologist

Treatment of nail psoriasis in Moscow – treatment of fingernails and toenails at the MedNail clinic

Cost of nail psoriasis treatment*

* the scope of services is determined by the doctor individually in each case

Nail psoriasis is a form of psoriasis that affects the nails on the hands and feet. It is important to note that in 30% of cases, psoriatic arthropathy (changes in the joints accompanied by pain) is added to psoriatic changes in the nails. Nail psoriasis often occurs together with psoriasis vulgaris (skin rashes).

How to suspect psoriatic onychodystrophy?

There are several objective signs characteristic of this pathology:

• symptom of “subungual splinters” – black longitudinal lines under the nails
• symptom of “oil spot” – round spots of yellow color
• onycholysis (detachment of the nail plate from the nail bed)
• thimble symptom

Important! Psoriasis has a chronic relapsing course and seasonal exacerbations are often noted, which means that most often nail changes disappear in winter and summer, and worsen in autumn and spring. Also, such changes can occur or intensify against the background of nervous stress, and improvements become noticeable at sea and on vacation. Often, regular exacerbations begin with pain and tingling in the area of ​​\u200b\u200bthe nails.

Psoriasis is a genetically determined disease. The patient often has among his relatives those who have been diagnosed with psoriasis.

The diagnosis of psoriasis is made only after the exclusion of other pathologies that can cause similar changes in the nails and a thorough history taking.

Treatment of nail psoriasis

There is an opinion that it is impossible to help a patient with psoriasis, but this is not true. Treatment of psoriasis on the nails of the hands and feet (or rather, achieving a stable remission) is quite realistic, however, it requires an integrated approach and active involvement of the patient in the process:

• At the appointment, the doctor will give recommendations on lifestyle and nutrition changes.
• Choose the right multivitamin based on your diet and physical activity.
• Learning how to properly care for nails with minimal trauma or regular visits to a specialist is a very important component in preventing recurrence.