About Psoriatic Arthritis And Psoriasis
Psoriasis is a chronic, inflammatory disease that typically affects the skin. In about 80 percent of cases, psoriasis manifests as a scaly, itchy rash of skin plaques that most frequently affects the elbows, knees, and scalp.
PsA is characterized by inflammation of the tendons and ligaments. Symptoms of psoriatic arthritis include lower back pain, inflammatory joint pain, and joint swelling and stiffness. Often, psoriatic arthritis also affects the nails, causing nail changes and symptoms such as pitting small dents in your nails. Left untreated, PsA can cause lasting joint damage. Approximately 1 in 5 people with PsA will experience spinal inflammation, known as psoriatic spondylitis. In some instances, spinal inflammation is so severe, it can cause complete fusion of the vertebrae, known as ankylosing spondylitis.
Treat Your Nails To Some Tlc
Whatever treatment you receive, its important to avoid irritating or injuring your nails. Irritation and injury can drive the inflammation that drives psoriasis, explains Dr. Kassouf.
Avoid picking at your nails and manipulating them, and steer clear of harsh chemicals, such as those found in acetone and non-acetone nail polish removers.
Follow these nail-care tips at home, too:
- Keep your fingernails and toenails trimmed short and filed evenly .
- If you have damaged nails, wear gloves when cleaning or doing work around the house.
- Always wear socks with shoes and make sure your shoes fit properly, so as not to irritate toenails further.
The progress for your nails may be slow. It can take three to six months before you see any improvement, Dr. Kassouf says. But most people do improve with the therapies available today.
What Does Nail Psoriasis Look Like
Nail psoriasis can affect your fingernails and toenails and will often manifest in these ways:
- Discoloration. Your nails are starting to brown, yellow or turn completely white.
- Damaged nail surface. You will notice lines, cracks, pits, holes or ridges. Basically, any nail surface that isnt smooth.
- Lifted nails. With nail psoriasis, white debris can begin to form under your nail, pushing it up and away from your skin. This is usually painful.
- Thinning or thickening texture. If your nails feels brittle or too thick, this can be the buildup of psoriatic skin cells under the nails, or it can be a fungal infection that can more easily invade the already-lifted nail. You will need a culture to determine the best treatment.
- Nail separation. Again, pretty painful. Depending on the severity of your nail psoriasis, your nail may start to separate itself from the nail bed.
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Types Of Psoriasis Pictures
Can you have psoriasis without scales? Many of you might face such questions coming into the mind. And now when you are informed about the types of psoriasis, you might think that there might different scenarios in different variety.
- Plaque Psoriasis- very common itchy and gives burning sensation with the formation of white and red scales.
- Guttate Psoriasis- very common in children, forms small red spots in the body.
- Inverse Psoriasis- Does not form scales forms red shiny skin with red patches which gets worse when comes in contact with sweat.
- Pustular Psoriasis- forms small spots in the arts of the body filled with pustules causing bumps.
- Erythrodermic Psoriasis- very uncommon, causes all over the body giving a color of burned skin to the normal skin
- Nail Psoriasis- causes infection in nails making them break or fall off easily.
- Psoriasis-Arthritis- Generally causes in old people, leads to problems in joints and bones.
However, you can also search for pictures of psoriasis online for better reference.
Note: If you are suffering from the serious problem of psoriasis and not in the situation of visiting a doctor at the moment, then undergoing certain treatment which is not harmful to you is useful. One such excellent treatment is provided by TopDermatology Product Manufacturers in IndiaAldan HealthCare, by the manufacturing Nygelis, psoriasis cream in India
Tips For A Diy Manicure And Pedicure With Psoriasis Or Psoriatic Arthritis
If you have psoriasis or psoriatic arthritis, many of the steps of an at-home manicure and pedicure are the same as, or similar to, a traditional treatment.
The key is to avoid traumatizing your nails. The overall handling trimming, filing, and buffing of your nails should be gentle, says Jacqueline Sutera, DPM, a podiatric surgeon in New York City.
These how-tos will help your nails look their best and possibly even keep your condition from getting worse.
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Determining The Differences Between Nail Psoriasis & Nail Fungus
To make this situation more complicated, patients with psoriasis are at a higher risk for nail funguses.2 Both nail fungus and nail psoriasis can have similar symptoms but are treated very differently.
This article will discuss some of the similarities, differences, risk factors and treatments of both nail fungus and nail psoriasis.
Optimal Management Of Nail Disease In Patients With Psoriasis
Accepted for publication 25 November 2014
9 January 2015Volume 2015:5 Pages 2533
Psoriasis is a chronic and recurrent inflammatory skin disease with nail involvement observed in approximately 80% of patients. Nail psoriasis may also occur as the only manifestation of the disease.1,2 Nail psoriasis can appear at any age and all nails can be affected. The nail matrix or nail bed can be involved in the disease. Nail psoriasis causes, above all, psychosocial and aesthetic problems, leading to significant repercussions in the quality of life, but many patients often also complain about functional damage.3 Cosmetic and functional damage, referred by 93% of patients with nail psoriasis, is sometimes so extensive that the patients tend to hide their hands and/or feet or shy away from social and business activities.4
The treatment of nail psoriasis involves different types of medications, from topical therapy to systemic therapy, according to the severity and extension of the disease. A standardized therapy does not exist, and the therapeutic choice is based on clinical manifestations and symptoms of the patient. Once the diagnosis has been defined, the severity of the disease should be assessed with a validated score, to decide the best treatment.
Figure 1 Nail matrix psoriasis of fingernails.
Figure 2 Nail bed psoriasis of fingernails.
Figure 3 Enhanced visualization of pitting with dermoscopy .
Assessment of psoriatic nail disease
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How Successful Are The Treatments
Anti-inflammatory drugs can help to reduce pain, swelling and stiffness. Unfortunately, however, they can make skin symptoms worse in some people. Steroid injections to joints may give relief. Disease-modifying drugs such as methotrexate can damp down both skin and joint symptoms, as can targeted biologic agents.
In some cases, surgery to remove a thickened synovial membrane , realign a joint or to fuse a joint may stop pain which results from movement.
Sometimes it is possible to remove the painful end of a bone .
Remember: All treatments may have unwanted side effects or require special precautions . Always make sure you have all the information before embarking on any course of therapy this includes reading the patient information leaflets provided with your medicines.
How Psoriasis Affects The Nails
Nail psoriasis occurs because psoriasis affects the process of nail formation. People who have nail psoriasis usually have psoriasis on other parts of their body, such as the skin and joints. Rarely does someone have only psoriasis of the nails.
Symptoms of nail psoriasis vary but may include:
- Discoloration of the nail to yellow-brown
- Pitting in the surface of the nails
- Horizontal lines across the nails
- White patches on the nails
- Thickening of the nails
- Nails that separate from the nail bed
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Treatments For Nail Psoriasis
The same treatments you get for skin psoriasis can also treat your nail psoriasis. Because your nails grow slowly, it can take time before you see any improvements in the newly grown parts of your nail.
The treatments for nail psoriasis include:
- Ultraviolet light is used to treat skin psoriasis and may also be useful in nail psoriasis. The treatments usually take place in a doctor’s office or a clinic.
- Medicines that work throughout your body. Your doctor may call these “systemic medications.” Some examples are:
Other Color Changes And Markings
- Melanonychia , especially on the thumb or big toe, may indicate subungual melanoma.
- White lines across the nail may be Mees’ lines or Muehrcke’s lines.
- Small white patches are known as leukonychia punctata.
- Dark nails are associated with B12 deficiency.
- Stains of the nail plate are associated with smoking, and henna use.
- Splinter hemorrhages are tiny blood clots that tend to run vertically under the nails.
- Drug-induced nail changes are caused by drug usage which may result in various abnormalities.:6656
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What Causes Nail Psoriasis
Psoriasis is a multifactorialsystemic disease including inflammation and epidermalhyperproliferation.
Nail psoriasis can involve the nail bed, nail matrix, hyponychium, and nail folds.
- Activation of the antimicrobialpeptide LL-37 by Candida and the cytokine overflow theory
- Increased expression of interleukin-10 in the affected nail bed compared to downregulation of IL-10 in psoriatic skin lesions
- Koebnerisation of psoriasis in onychomycosis or nail trauma.
When Should Someone Seek Medical Care For Nail Psoriasis
If there are changes in the nails such as discoloration or pits or if the nails seem infected or are painful, see a doctor.
At present, psoriatic nail disease does not have a cure. The goal of treatment is to improve the function and appearance of psoriatic nails. If the nails have a fungal infection, a doctor will prescribe an antifungal medication.
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Expert Q& a: Psa Without Psoriasis
Learn how doctors diagnose psoriatic arthritis without skin symptoms present.
Question: Is it possible to have PsA but no psoriasis symptoms?
Answer: Yes, it is certainly possible to have PsA with no psoriasis/skin symptoms. For the majority of people with PsA, psoriasis precedes the onset of arthritic symptoms, but some people develop the skin disease after the onset of arthritis. So, there may be a period of arthritis without psoriasis. Less commonly, people with psoriatic arthritis may never develop psoriasis, but they often have a family history of psoriasis or psoriatic arthritis. Whether a patient has psoriasis or not, the diagnosis of psoriatic arthritis is made on the basis of clinical symptoms, as there are no diagnostic laboratory tests. Patients with psoriatic arthritis typically present with joint pain and swelling and morning stiffness. Other symptoms include inflammatory low back pain, which improves, rather than worsens, with activity enthesopathy, or inflammation at the sites where tendons and ligaments attach to the bone dactylitis nail changes and eye inflammation.
Steven R. Feldman, MD, PhD
Department of DermatologyWake Forest Baptist Medical Center
Is It Possible To Have Psoriatic Arthritis Without Psoriasis
People with the autoimmune disease psoriatic arthritis usually also have the skin condition psoriasisbut not always.
Experts in the field of psoriatic arthritis have long faced a chicken-and-egg question: Can you have psoriatic arthritis without having psoriasis first? Some say yes. Some say no. Others say yes and no.
“There is a lot of debate going on,” says Ted Mikuls, MD, professor of internal medicine in the division of rheumatology at the University of Nebraska Medical Center in Omaha.
Like psoriatic arthritis, psoriasis is an autoimmune disease, meaning the immune system attacks a part of the body. With psoriasis, the immune system attacks the skin , while psoriatic arthritis attacks the joints . About 80-85%of people who develop psoriatic arthritis have psoriasis first, according to the National Psoriasis Foundation. For the remaining 15-20%, arthritis precedes the skin condition.
“It is much, much more common to have the psoriasis first,” says Marcy OKoon Moss, senior director for consumer health at the Arthritis Foundation in Atlanta.
But the question remains: If a patient first experiences joint symptoms of psoriatic arthritis, does that mean they don’t have psoriasisor just that their psoriasis hasnt been detected yet?
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Group Gr And Group It Epidemiological Data
A total of 68,839 children aged 6-17 years were seen in pediatric skin consultation over a period of 10 years at both clinics . The number of patients/year is shown in figure 2. The total number of patients at the pediatric age affected by skin psoriasis was 406 , 284 in Group GR and 122 in Group IT, corresponding to 0.9 and 0.31% of the pediatric population, respectively. Furthermore, a total of 74 out of the 68,839 children had involvement of the nails: 55 out of 30,044 in Greece and 19 out of 38,795 in Italy, which equals 0.18 and 0.05% of all pediatric skin consultations, respectively . With regard to the children with skin psoriasis, the rate of children affected by nail psoriasis was 19.4% in Group GR and 15.5% in Group IT.
For additional information:
What Are Nail Psoriasis Causes And Risk Factors
Psoriasis is not contagious. How psoriasis of the nails develops is not completely known. Nail involvement appears to result from a combination of genetic , immunologic, and environmental factors.
Psoriasis tends to run in families. About 40% of people with psoriasis have a first-degree relative who is known to have the condition. If both parents have psoriasis, a person’s risk is up to 75%. Males and females are equally likely to have psoriasis. Psoriasis can occur in people of all races.
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How Common Is Psoriatic Nail Disease
About 1 in 50 people have psoriasis at some time in their lives. It can first develop at any age but it most often starts between the ages of 15 and 30 years. Nail changes occur in about half of all people with psoriasis, so about 1 in a 100 people.
About 4 in every 5 people with psoriatic arthritis have psoriatic nail disease. See the separate leaflet called Psoriatic Arthritis for more details.
Only a few people have psoriatic nail disease without having psoriasis affecting either their skin or their joints.
Prevention Of Nail Psoriasis
Good nail care is the best way to treat nail psoriasis. Try these prevention tips:
- Keep your nails trimmed short.
- Use a nail file to keep nail edges smooth.
- Wear gloves to clean and do other work with your hands.
- Moisturize your nails and cuticles every day and after they’ve been in contact with water.
- Wear comfortable shoes with enough room for your toes.
If you’re unhappy with the way your nails look, try nail varnish or artificial nails. They can also protect your nails from more damage. Some people are sensitive to the chemicals in varnish and nail adhesive. Talk to your doctor about whether these are right for you.
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Treatment Options For Nail Fungus And Nail Psoriasis
There are treatments for both nail fungus and nail psoriasis. Nail fungus is usually treated with medication. Patients may be given topical medication that is applied directly to the nail.2
These are available as creams and polishes and may be used in conjunction with other treatments. Nail fungus patients may also be prescribed an oral antifungal medication.2 Oral medications are usually given for 12 weeks to 6 months. They can be used with or without topical treatments.
Nail psoriasis can be treated with topical corticosteroids.1 Some patients have had success with corticosteroid injections under the nail since it is difficult for topical medications to get through the nail into the nail bed.3
Overview Of Nail Psoriasis
Psoriatic nail disease has many clinical signs. Most psoriatic nail disease occurs in patients with clinically evident psoriasis it only occurs in less than 5% of patients with no other cutaneous findings of psoriasis.
An estimated 10-55% of all patients with psoriasis have psoriatic nail disease, and approximately 7 million people in the United States have psoriasis. About 150,000-260,000 new cases of psoriasis are diagnosed each year. US physicians see 1.5 million patients with psoriasis per year.
Severe psoriatic nail disease can lead to functional and social impairments if left untreated.
See the images of psoriatic nail disease below.
See 15 Fingernail Abnormalities: Nail the Diagnosis, a Critical Images slideshow, to help identify conditions associated with various nail abnormalities.
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Overview Of Treatment Of Nail Psoriasis
Many treatment options are available after the diagnosis of nail psoriasis is made. The treatments focus on improvement of the functional and psychosocial aspects of psoriatic nail disease.
The treatment options for nail psoriasis include topical corticosteroids, intralesional corticosteroids, psoralen plus ultraviolet light A , topical fluorouracil, topical calcipotriol, topical anthralin, topical tazarotene, topical cyclosporine, avulsion therapy, and systemic therapy for severe cases. Onychomycosis requires antifungal therapy for improvement. Laser and light therapies have emerged as possible cost-efficient, in-office treatments however, large-scale trials are needed, particularly in consideration for the effects in combination with other current therapies.
For preventive care, keep the nails dry and protect them from trauma to avoid the Koebner effect and possible secondary microbial colonization. In areas of onycholysis, the nail plate should be trimmed to the point of separation for medications to be effective.
At present, no definitive and curative treatment has been agreed upon by medical experts. Discuss all treatment options for psoriatic nail disease with the patient, and choose the best individually tailored regimen.