Nail Psoriasis | Causes, Symptoms, Cures

Psoriasis is a chronic inflammatory skin disease affecting 7.4 million people in the United States alone. It is prevalent in 1-2 % of the world population with variations based on region and skin types. It causes red, itchy, and scaly patches affecting various parts of the body including the chest, arms, legs, trunk,scalp and nails.Nail psoriasis affects upto 50 % of people suffering from psoriasis and 80% of people suffering from psoriasis arthritis. 

Nail psoriasis changes the structure of the nail, altering its physical appearance. It is unsightly and if diagnosed must be immediately treated with a dermatologist’s help. The disease can affect fingernails as well as toenails. It can affect any age group, race, sex, although male predominance is reported largely.

There are various traditional and advanced treatments available for nail psoriasis. Cosmetic repairs are also a promising option available to treat psoriasis of nails. 

 

What is Nail Psoriasis?

If you have psoriasis you may observe few changes in your nails. Psoriasis of skin and psoriatic  arthritis both can be associated with nail psoriasis. Discoloration, thickening of the nail, and pits over the nail surface are few of the typical nail changes seen. They may also appear thinner and become painful over time. 

Image of nail psoriasis in fingernails.

 

Symptoms of Nail Psoriasis

Image of toenails affected by nail psoriasis

The following symptoms are commonly seen in psoriasis nails,

  • Changes in Color: The color of your nails may change to white, yellow, or brown. It begins as a small white or yellow spot and then advances to the cuticle. Small red or white spots may appear on the nail surface. In some cases, a spot of oil may appear underneath the nail surface.
  • Pitting of the nail surface: Nails are made up of keratin-the same protein that makes up our hair and skin. Nail Psoriasis causes the nail plate to lose many cells forming grooves or pits on the surface. In addition to pitting, lines may appear on your nail surface too. These lines are called Beau’s line formed across the surface. 
  • Subungual hyperkeratosis: Debris or dead skin cells can accumulate underneath the nail plate lifting the nail. This can turn painful over time.
  • Onycholysis: Nails separate from the skin underneath them. This is called onycholysis, it leaves space underneath the nail surface. There are high chances of fungal growth in these empty spaces.
  • Onychomycosis- Nail psoriasis can develop into a fungal infection resulting in thick nails. Research says that 35% with nail psoriasis develop a secondary fungal infection of nails making the treatment even more challenging. 

What Causes Nail Psoriasis?

Psoriasis is an autoimmune skin disorder. It alters the immune system and causes an increase in skin cell turnover in the body. The disease causes unsightly skin patches to develop and may disrupt the individual’s quality of life.

It can also make one self-conscious. Various environmental and genetic factors cause the disease. Many theories explain the etiology of the disease,

  • Candida (a type of fungus) stimulates the production of superantigens and secretion of cytokines that can initiate pathogenesis
  • Increased expression of Interleukin-10 (IL-10) in the affected nail bed
  • The appearance of skin lesions due to nail trauma

How to treat Nail Psoriasis?

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 treatment

Topical treatments are common to treat psoriasis nails. They are applied once or twice a day. They are available as,

  • Paints
  • Creams
  • Ointments
  • Emulsions

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 medication

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. 

Prevention of Nail Psoriasis

In addition to medication, the following preventive measures should be taken to treat nail affected by nail psoriasis,

  • Trimming your nails regularly and keeping them short. Cut them straight to avoid any curved areas.
  • Avoid damaging your nails to worsen the matter and prevent fungal growth in cracks.
  • Refrain from biting or picking your nails and cause any type of injury.
  • Wear protective gloves when working in the garden, lifting heavy objects, etc.
  • Moisturize your nails often to prevent them from drying.
  • Soaking your nails in warm water will help soften them. Afterwhich, you can use your nail grooming kit.
  • Sterilize your nail grooming kit after every use and avoid sharing it with family members. 
  • Wear well-fitted and comfortable footwear.

Home Remedies for Nail psoriasis

Home remedies cannot completely treat nail psoriasis however, they can reduce a few symptoms. The following home remedies can help relieve symptoms,

  • Aloe Vera
  • Turmeric
  • Dead sea salt
  • Capsaicin 

Using indigo naturalis, herbal medicine has proven to be effective in improving thickened nails and onycholysis. 

 

When to see a doctor?

It is highly recommended that people with psoriasis must consult their dermatologists for diagnosis and prescribed treatment. The National Psoriasis Foundation recommends immediate diagnosis and treatment and patients to seek medical help. 

If the disorder has relapsed or has aggravated over time you should seek a certified dermatologist's help and guidance. Your doctor will suggest personalised treatment options, new therapies, or alternative therapy.  

 

How to hide Nail Psoriasis?

If you feel self-conscious about your nails you can try cosmetic treatments as well. Nail filing, buffing, and using nail polish can hide nail psoriasis. 

Patients should avoid getting fake or acrylic nails done. As it will increase the chances of separation from the nail bed and promote fungal infections.

Psoriasis is a chronic inflammatory disorder affecting many people all over the world. It significantly impacts the quality of your life and mental well-being. It is important to manage it well, take precautionary measures and treatment at the right time. Ongoing research has suggested various new therapies and is striving to find a cure for psoriasis. 

 

Seeking a dermatologist's help?

Finding a trustworthy dermatologist who will provide genuine guidance to you can be challenging at times. 

Since its inception in 2018, SkyMD has been providing the best dermatologists in the United States. Their vision is to provide the most accessible telemedicine platform virtually all over the United States. 

Patients are at the core of this virtual clinic and they provide online assistance throughout the day. 

The team of dermatologists has a collective experience of over 1,000,000 cases with a broad range of specializations. 

Book an appointment to speak to your dermatologist today!

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