What Nail Psoriasis Looks Like
Nail psoriasis causes changes to your fingernails and toenails
This fingernail shows 3 signs of nail psoriasis: Crumbling, roughness, and blood under the nail .
Common signs of nail psoriasis
This nail also has 3 signs of nail psoriasis: Tiny dents in the nail , white discoloration, and lifting .
Most people who have plaque psoriasis develop nail psoriasis
Discoloration , nail lifting from the finger, and a thin line of blood are common signs of nail psoriasis.
Nail psoriasis usually begins years after psoriasis first appears on the skin
This patients nail has 3 common signs of nail psoriasis: Grooves, blood beneath the nail , and lifting of the nail from the finger.
Nail psoriasis can be mild
If you have psoriasis, ridges and a thin line of blood beneath the nail can be signs of nail psoriasis.
Improvement from treatment happens slowly
Nails grow slowly, so it will take 6 months or longer to clear debris, a common sign of nail psoriasis, beneath the nail.
Burden Of Nail Psoriasis: The Impact Of Nail Psoriasis On Quality Of Life
Nail psoriasis engenders both physical and psychological handicap, leading to significant negative repercussions in the quality of life. Cosmetic handicap in nail psoriasis is sometimes so extensive that the patients tend to hide their hands and/or feet or shy away from social and business interactions. The burden of nail psoriasis on its sufferers can be imagined from the results of a study done by de Jong et al., in 1728 patients, which showed that nail psoriasis caused significant cosmetic handicap in 93% of patients, restriction of daily housekeeping and professional activities in 60% patients, and 52% patients described pain as a symptom. In 2009, Ortonne et al., devised the Nail Psoriasis Quality of Life Scale-NPQ10-to evaluate the impact of nail psoriasis on quality of life. The scale correlated well with the Dermatology Life Quality Index. A valid and reliable questionnaire consisting of 10 questions was prepared with all the questions specifically targeting the impact of nail psoriasis on quality of life. The questionnaire was answered by 1309 patients and showed that 86% patients considered nail psoriasis as bothersome, 87% as unsightly, and 59% as painful. Such an impact of nail psoriasis definitely warrants an insight into its clinical manifestations and treatment options by a present day dermatologist.
What Is Nail Psoriasis
Etymologically, psoriasis comes from the Greek psora, which means itching. The dead cells that are in the epidermis, which is the outer layer of the skin, are replaced by new cells. This process takes place approximately every 30 days.
However, when this renewal accelerates more than the average, then what is called psoriasis occurs. This disease causes redness on the skin or scales. These usually cause pain and itching, which can often affect the nails.
Psoriasis of the nails is defined by various abnormalities that occur on the nails of the hands and feet. Most of the time, there are small depressions that look like thimble holes, detachments or crumbling, discoloration, thickening or streaking on the nails.
On the other hand, psoriasis lesions on the nails are normally more common on the hands than on the feet. However, very often, these are the only signs of psoriasis in a person affected by this disease.
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Home Remedies For Nail Fungus
Can you fix nail fungus on your own? There are many home remedies that claim this for example, vinegar has been pointed out as a useful weapon in the fight against infection.
Hälsoliv has previously undergone various types of home remedies for nail fungus and few are recommended by an expert:
What Does Nail Psoriasis Look Like
Clear yellow-red nail discoloring that looks like a drop of blood or oil under the nail plate: This is known as an oil drop or a salmon patch and is a sign of nail psoriasis. Little pits in the nails or pitting of the nail matrix. Pits develop when cells are lost from the nails surface.
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How To Treat Nail Psoriasis
Specific treatments to eliminate nail psoriasis are generally unsatisfactory. These are, moreover, generally intended for cases in which there is a functional deterioration or which considerably affect the aesthetic part of the nail.
However, there are several natural alternatives that you can use at home to combat the effects of psoriasis on nails. Discover them all!
Here are 5 natural remedies to fight against nail psoriasis:
1 Creams with Vitamin D to fight against nail psoriasis
Vitamin D contains anti-inflammatory properties and promotes the healing of damaged nails. Therefore, creams or lotions containing vitamin D will be the most recommended for treating nails with psoriasis.
What do you need ?
A good vitamin D-based ointment or cream that you can buy from Amazon here: Dr. Shepards Vitamin D3 Cream
What should you do ?
- Rub the vitamin D-based ointment or cream on the nail affected by psoriasis for about 5 minutes.
- Apply the treatment 2 to 3 times a day until the nail is improved.
- Similarly, it is advisable to follow an appropriate diet so that the healing process also takes place from within.
2 Aloe Vera to fight against nail psoriasis
Aloe Vera
Aloe Vera is a plant famous for its many medicinal properties. In addition, it is easy to obtain, making it one of the most popular natural remedies. On the other hand its use for the treatment of nail psoriasis is relatively simple.
What do you need ?
What Can You Do To Help Improve Psoriatic Nail Disease
- Keep your fingernails and toenails as short as possible – long or loose nails are more likely to catch and can cause more damage to the skin underneath the nail.
- Keep your nails dry.
- Protect your nails by wearing gloves when doing any manual work.
- Avoid a manicure of the base of the nail. This may cause an infection.
- Avoid false nails as they may damage the cuticle and make it difficult to apply treatments to the nail.
- Nail varnish can be used to cover up pitting. Nail varnish remover containing acetone should not be used, as it can cause damage to the nail.
- If you have painful toenail psoriasis then you should see a person who is qualified to diagnose and treat foot disorders .
Note: if you have psoriatic nail disease and develop pain or swelling in one or more of your joints or if you develop pain in your heel then you should see your doctor as soon as possible. You may be developing psoriatic arthritis. It is important that you are seen by a doctor specialising in joint diseases early. It has been shown that the sooner this condition is treated, the less likely you are to suffer permanent damage to your joints.
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Keep Your Nails Clean And Dry As Much As You Can
Moisture and warmth can promote bacterial and fungal growth, Patel points out, noting that thick, uneven nails with cracks and holes , is a perfect breeding ground. Using Vicks VapoRub on your nails at night helps decrease microbe growth, so does soaking your nails in Listerine Original Antiseptic the active ingredients help kill microbes and prevent infections.
What Triggers Nail Psoriasis
Psoriasis of the nails is caused by the same autoimmune mechanisms as psoriasis of the skin. For reasons not entirely clear, the immune system will inexplicably regard normal tissues as harmful and launch an immune assault. Although the skin is the primary target, other tissues are affected as well.
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Treatment Of Nail Psoriasis: Common Concepts And New Trends
Yasemin Oram
1Department of Dermatology, V.K. Foundation American Hospital of Istanbul, Turkey
Abstract
The lifetime incidence of nail involvement in psoriatic patients is estimated to be 8090%, and the nails can be affected in 10% to 55% of psoriatic patients. Psoriasis may also solely involve the nails, without any other skin findings, in which the treatment can be more challenging. Nail psoriasis may lead to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain, which may be overlooked by the physicians. Several topical and systemic treatment modalities, as well as radiation and light systems, have been used in the treatment of nail psoriasis. In the last decade, the introduction of biologic agents and the utilization of laser systems have brought a new insight into the treatment of nail psoriasis. This paper focuses on the recent advances, as well as the conventional methods, in treating nail psoriasis in adults and children, in reference to an extensive literature search.
1. Introduction
2. General Nail Care
3. Topical Therapy
There is limited evidence for the efficacy of topical therapies in nail psoriasis. Various topical treatment modalities have been used in nail psoriasis including corticosteroids, dithranol, fluorouracil, vitamin D3 analogues, tacrolimus, cyclosporine, and tazarotene .
4. Intralesional Therapy
6. Systemic Therapy
7. Biologic Treatments
The Advent Of New Treatment Options: Biologic Therapy
Overall, the conventional treatment for nail psoriasis appears to be unsatisfactory, tedious, and inconvenient. Most of the treatment options achieve only a moderate efficacy, complete clearance is infrequent and efficacy of conventional therapy decreases with time. This clinical challenge faced by many dermatologists has recently been addressed with the introduction of the biological response modifiers. These agents have demonstrated efficacy in both the skin and nail components of psoriasis.
Infliximab
The best studied biologic agent is infliximab. The best evidence comes from the EXPRESS trial which was a phase-3 double-blinded, placebo-controlled trial . A total of 378 patients with moderate to severe plaque type psoriasis with nail involvement were randomly assigned in a ratio of 4:1 to receive infliximab 5 mg/kg at weeks 0, 2, 6, and every 8 weeks till week 46. Placebo was given at 0, 2, 6, 14, 22 and crossing over to infliximab occurred at week 24. This study showed that infliximab resulted in significant improvement in nail psoriasis as early as week 10 and at week 50 full clearance was evident in 45% of patients.
Etanercept
Adalimumab
In a study done by van den Bosch et al., 40 mg of adalimumab every other week reduced the mean NAPSI score by 65% after 20 weeks .
Ustekinumab
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Common Symptoms Of Nail Fungus
The fungus usually attacks our toenails but can also affect fingernails.
Symptoms that often appear in connection with nail fungus are the following:
- Discolored gray-yellow nail
- Nail that easily crumbles.
- The nail may come loose from the toe.
It is common for not all nails to be affected at the same time. The fungus can also affect the skin around the toe or toes themselves and the sides of the foot. Foot fungus can occur at the same time as nail fungus and cause additional symptoms.
How To Hide Nail Psoriasis
If you feel self-conscious about your nail psoriasis, there are some things you can do to make it less noticeable.
Cosmetic treatments such as nail filing, buffing, and polish can improve the appearance of your nails while they heal. Just avoid fake nails, which may increase the risk of your nail separating from its bed.
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Optimal Management Of Nail Disease In Patients With Psoriasis
Accepted for publication 25 November 2014
9 January 2015Volume 2015:5 Pages 2533
Introduction
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.
Clinical manifestations
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Figure 1 Nail matrix psoriasis of fingernails. |
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Figure 2 Nail bed psoriasis of fingernails. |
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Figure 3 Enhanced visualization of pitting with dermoscopy . |
Diagnosis
Assessment of psoriatic nail disease
Epidemiology Of Nail Psoriasis
Psoriatic nail disease occurs in 10-55% of all patients with psoriasis, and approximately 7 million people in the United States have psoriasis . Less than 5% of psoriatic nail disease cases occur in patients without other cutaneous findings of psoriasis. About 10-20% of people with psoriasis also have psoriatic arthritis, and nail changes are seen in 53-86% of patients with psoriatic arthritis.
Psoriasis tends to run in families. In Farber’s questionnaire study of 2100 patients, 36% of patients reported the presence of psoriasis in at least 1 relative. Among siblings, 8% are affected if neither parent has psoriasis. This percentage increases to 16-25% if 1 parent or sibling has the disease, and it reaches up to 75% if both parents are affected. If 1 twin has psoriasis, the other twin is at an increased risk of having psoriasis .
In Scandinavia, the prevalence rate of nail psoriasis for adults with psoriasis approaches 5%. The prevalence increases with the age of the population studied.
Psoriatic nail disease is not associated with mortality. In severe cases, patients may have functional and psychosocial impairments.
Males and females are affected equally by nail psoriasis, and the prevalence of nail psoriasis increases with the age of the population studied.
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Nail Psoriasis Quick Guide
Learn more about the signs of nail psoriasis, Treatment options and get tips for caring for your nails without making your nail psoriasis worse.
Betteridge, N., Boehncke, W. H., Bundy, C., Gossec, L., Gratacos, J., & Augustin, M. . Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol, 30, 576-585. doi:10.1111/jdv.13306
Jiaravuthisan, M. M., Sasseville, D., Vender, R. B., Murphy, F., & Muhn, C. Y. . Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol, 57, 1-27. doi:10.1016/j.jaad.2005.07.073
Merola, J. F., Li, T., Li, W. Q., Cho, E., & Qureshi, A. A. . Prevalence of psoriasis phenotypes among men and women in the USA. Clin Exp Dermatol, 41, 486-489. doi:10.1111/ced.12805
How Is Nail Psoriasis Treated
Just like psoriasis that impacts other areas of the body, nail psoriasis can be treated in many of the same ways. Nail psoriasis can take longer to treat and results may be seen slowly, due to the slow growth and replenishment of new nails. However, treatment options for nail psoriasis may include:
- Medication applied to the nails. The doctors of Skin Center of South Miami may first prescribe a topical medication that can be used directly on the nail and around the finger or toe. These topical medications may include corticosteroid treatments, retinoid creams, or vitamin D lotions. These medications are often applied to the area several times a day to achieve results.
- Injections. Some patients may do best with a corticosteroid injection that is administered directly under the surface of the nail every few months. A nerve block or anesthetic will be used to numb the area. This treatment is often recommended for patients with severe or recurring nail psoriasis.
- Systemic medication. Oral medications that work from the inside out may also be used for the treatment of nail psoriasis. These may include medications such as methotrexate, cyclosporine, apremilast, and acitretin.
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What Is Psoriatic Nail Disease
Psoriatic nail disease is a type of psoriasis. It is not caused by infection and you cannot pass it on to anyone else.
Psoriasis is a common skin condition that usually causes patches of red, scaly skin but sometimes only affects the nails. There is also a form of arthritis that is linked to psoriasis, called psoriatic arthritis. Psoriatic nail disease is particularly common if you have psoriatic arthritis. You can read more about these conditions in the separate leaflets called Psoriasis and Psoriatic Arthritis.
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How Do I Get Rid Of My Nail Fungus
Nail fungus is a fungal infection of the nails that can cause brittle and thickened nails. The first sign of nail fungus is that the surface where the nail is cut becomes fringed. The nail bends and the sides begin to penetrate the toe. It is usually a thread fungus, but yeast and mold can also be behind it. According to Netdoktor, it can also be confused with so-called psoriasis nails.
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Pathophysiology Of Nail Psoriasis
The pathogenesis of the psoriatic nail disorder is not completely known. Nail psoriasis may be due to a combination of genetic, environmental, and immune factors. A well-known fact is that a familial aggregation of psoriasis exists. Studies have linked psoriasis with certain human leukocyte antigen subtypes . A T-cellmediated inflammatory process is being investigated as part of the pathogenesis of psoriasis.
Be Extra Gentle With Your Nails
Since nail psoriasis is often associated with general brittleness, Skotnicki says to be extra gentle with your nails. And this goes beyond not picking at them. She also recommends shielding them from harsh environments by wearing cotton or rubber gloves when washing the dishes, gardening, or cleaning the house.
Grace Cary / Getty Images
Vitamin E oil and fish oils have been shown to help with inflammation of the nail beds, and can help with the cuticles and growth of nail with nail psoriasis, Patel says. Our favorite vitamin E-infused cuticle product is none other than Olive & Junes Cuticle Serum .
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