Treatment for nail psoriasis can be customised as per the patients need and extent of nail involvement. Traditionally, antifungal drugs and topical treatments were majorly used. Nowadays, many advanced treatments are also available to deal with psoriasis nails in severe cases.
Topical treatments are common to treat psoriasis nails. They are applied once or twice a day. They are available as,
Corticosteroid injections or creams applied on affected nails have been effective in reducing a few symptoms. These symptoms include thick nails, elevated nails, and separation.
Dermatologists have also prescribed vitamin D analog preparations for nail psoriasis. Rubbing vitamin D analog ointments or cream have reduced various symptoms related to the disease. For best results, vitamin D analog ointments or creams should be massaged on the cuticle for 5 minutes twice a day.
Calcritrene, Dovonex, and Calcitriol are manmade preparations of vitamin D. They help in effectively reducing excessive skin cell production and inflammation.
Retinoid-containing ointments such as Tazarotene have also proven to be quite effective in reducing some symptoms of nail psoriasis. It reduces pitting, discoloration, and separation of the nail from the nail bed.
Topical therapies alone are not adequate to treat psoriasis nails as relapse is a common issue. A combination of treatments has proven higher efficacy and low chances of relapse.
Oral medications like cyclosporine, methotrexate, apremilast, and retinoids are prescribed as pills, liquids, or injections. These drugs help clear out moderate to severe psoriasis.
Research has shown the efficacy of various biologic drugs like adalimumab (Humira), infliximab (Remicade), etc to suppress the overactive altered immune response central to causing psoriasis.
Various antifungal drugs fight against fungal growth in psoriasis nails.
Removal of nail
In several cases, affected nails can be removed painlessly by using a high concentration of urea and phenol. The nail becomes jelly-like and can be peeled off. Surgery can also be done to remove nails although the nail will grow back. Hence, it is not the most preferred option.
Phototherapy/ Light Therapy
Phototherapy also called light therapy has proven effective in treating nail psoriasis. It reduces pain and itchiness goes away. In the treatment process, affected nails are exposed to a light source which decreases the production of new cells. Light therapy involves exposure to the following light sources,
- UV radiations from the sun
- LASER-Pulse dye laser (PDL)
- Phototherapy unit
First, you soak your nails in psoralen solution and later expose them to UV radiations. This treatment reduces discoloration and nail thickening. This in turn reduces the chances of fungal infection and improves the appearance of your nails.