Nail Psoriasis or Fungus? How to know? When to see a doctor?

Person cleaning nail bed

Imagine a great mani-pedi session leaving your hands and feet feeling soft and clean. Sounds great right? But wait? Are you seeing some unusual changes on your nails? Discoloration? An unseen spot? Cracking? Your nails might be trying to tell something.

Our nails are made up of keratin-the same protein that makes up your skin and hair. There are times when the keratin structure is altered, damaged, or taken over by fungal infections.

It is not uncommon to have trouble with your nails. However, sometimes it can get complex if not treated timely. You may be suffering from nail fungus or nail psoriasis.

Nail fungus or Onychomycosis is an infection caused by fungus growing in your nails. It is a contagious disease that begins as a white or yellow spot on your nails. The fungus can spread rapidly infecting your entire nail. It may even turn brown or black if left untreated.

 Infected nails

 

Psoriasis is a chronic autoimmune skin disease. People suffering from this disease have red, scaly patches on their skin. Psoriasis is a genetic autoimmune disease that spreads to your chest, trunk, fingernails, and toenails. Fingernail and toenail psoriasis is caused due to psoriasis. 

Yellow and brittle nails

Toenails and fingernails are susceptible to both of these nail infections. If you notice any of the below-mentioned symptoms, you must seek help from your dermatologist immediately. 

There are high chances that people may get confused in differentiating between nail fungus and nail psoriasis. Few common symptoms can make diagnosis complex. Therefore, it is important to understand the differences to diagnose the disease correctly and prescribe appropriate treatment.

 

Difference between Nail Psoriasis and Nail Fungus | Symptoms 

There are high chances of getting confused between nail psoriasis and nail fungus. They have many similarities. Hence, it becomes important to tell them apart for correct diagnosis and treatment.

Symptoms of Nail Fungus

Symptoms of Nail Psoriasis

Deformation and thickening of nails

Pitting, deformation and thickening if nails

Darkening of the nails

Small red or white spots appear on the nail bed

Nail shape can get distorted

Nails turn yellow or brown in color

Brittle and dull nails

Debris build up underneath lifting the nail from its bed

Foul-smelling

Nails detaches from the bed and creates empty spaces in between

Discharge may be present in some cases                       

It can be painful 

Nail Psoriasis

Psoriasis is a systemic (body-wide) skin disease affecting many parts of the body. It is a chronic inflammatory disease, and may also cause back and joint pain. A person suffering from the disease may have psoriasis fingernails and psoriasis toenails. Psoriasis fingernails are more common than toenail psoriasis. Red, scaly patches of skin can be visible on the chest, arms, legs, and trunk as well. 

Research states that nearly 125 million people are suffering from psoriasis globally. A permanent cure of the disease is not found yet, however, it can be managed with proper guidance. The disease has a significant impact on one’s mental well-being and quality of life. 

There is no such thing as a friendly fungus

Except for the mushrooms on your pizzas, finger fungus is rarely appreciated. You certainly don’t want it to grow anywhere on your body. 

Onychomycosis is a contagious fungal infection, causing thickening and discoloration of the nail plate. It is the most common type of nail infection, affecting 10% of the world population. Nail fungus affects toenails more than fingernails. 

As it is highly contagious, one can contract the disease from an infected person or because of poor hygiene. Fungus thrives in damp or sweaty areas of the body. Athletes and people working in damp places barefoot are highly susceptible to nail fungus. 

People with existing ailments such as diabetes or HIV/AIDS have more chances of contracting nail fungus. Hence it is also possible that nail fungus can indicate an underlying ailment in a person. 

Can a patient have both Nail psoriasis and Nail fungus?

Yes, a person can be infected with both nail psoriasis and nail fungus. People with psoriasis can develop a secondary fungal infection. Although, people with nail fungus might not necessarily suffer from nail psoriasis.

Increased chances of Athlete's foot

If the nail fungus spreads to the skin on your feet it is called Athlete's foot. Symptoms include itchy and dry skin between the toes or on your soles, cracking, and peeling of the skin. 

People suffering from athletes’ feet have high chances of developing nail fungus. As the name suggests, athletes are at high risk of contracting the disease. However, it can infect anyone if preventive measures are not taken timely. 

Symptoms for Nail Fungus

The fungus affects toenails more than fingernails. Toenails have more chances of coming in contact with fungus while walking barefoot. If an infected person has walked in a public place, they can spread the infection to others. The following symptoms will help you diagnose finger fungus correctly.

Nail color changes to grey, green or brown depending on the sub species of fungus causing. It begins as a spot and then spreads to your entire nails. Such hyperpigmentation is not observed in nail psoriasis. 

Nails become more brittle, crumbled and patches may develop. It easily spreads throughout as your nail grows. 

Nail fungus can also spread to other uninfected nails and the surrounding skin.

Symptoms for Nail Psoriasis

Fingernail psoriasis is more common than toenail psoriasis. It is characterized by yellowing and pits all over the nail surface. 

Psoriasis nail is more likely to detach your nail from the nail bed, leading to nail loss. Fungal infections rarely lead to nail detachment. 

The nail may break or entirely pull apart, leaving a gap between your fingertip and the nail.

Pits become deeper with time and sometimes even holes are formed. Nails become very dry and many ridges are formed, altering the appearance of your nails. 

How to Treat Nail Fungus?

There are many topical antifungal creams, liquids, and ointments available in the market. In severe cases, your doctor may prescribe antifungal pills such as fluconazole, griseofulvin, terbinafine, itraconazole, etc. Sometimes, a doctor may suggest the removal of the infected nail to avoid the spread of the fungus. 

How to treat Nail Psoriasis?

Treatment of nail psoriasis is complex as there are high chances of relapse. Traditionally, many topical ointments and injections containing Steroids, retinoids, Vitamin D analogs as well as oral antifungal drugs were used. Different drugs target and alleviate specific symptoms. 

More advanced treatment options include the use of phototherapy (sunlight, UV radiations and laser) and inducing biologics to treat nail psoriasis. The disease can be managed by various treatment options, however, a permanent cure has not been discovered yet. 

A combination of treatments may prove to be effective. Research suggests that the following treatment options are beneficial for nail psoriasis,

  • Corticosteroid injections
  • Induction of biologics such as Interleukin-17 (IL-17) inhibitors
  • Phototherapy or light therapy
  • Use of oral medication such as cyclosporine, methotrexate and apremilast

When to see a doctor?

It is essential to diagnose the nail disease correctly to treat it timely. Psoriasis is a genetic disorder. If you have psoriasis or a family history of the disease you must seek a doctor’s help. 

Finger fungus is also a complex and contagious disease and you must see your dermatologist begin the appropriate treatment. 

Meanwhile, you must take the following preventive measures,

  • Groom your nails often and sterile your grooming kit after every use.
  • Keep your feet and hands clean and dry.
  • Trim your nails straight, avoiding curved surfaces.
  • Wear properly fitted shoes.
  • Avoid sweaty shoes, socks or feet.
  • Don’t go barefoot in public places (Sauna and locker rooms).
  • Go to salons that adhere to proper sanitation standards.
  • Apply nail moisturizer often to get soft nails. 

Since nail psoriasis is an autoimmune, genetic  disease it cannot be prevented by good hygiene, however, nail fungus can be kept at bay by adhering to these preventive tips.

Only a medical expert can confidently determine the type of nail disease based on symptoms. Timely treatment can help manage both these diseases. 

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