Comparative Studies With Systemic Therapies
The efficacy of biologics has not only been a matter of research but differences in the occurrence of adverse events have also been investigated. A prospective, randomized, open-label study compared the incidence of onychomycosis in 315 patients with nail psoriasis treated with infliximab, etanercept, and adalimumab, and a statistically positive association between fungal infections and the use of infliximab was shown . At the end of week 24, 33 % of patients receiving infliximab had a positive fungal culture. In patients receiving etanercept and adalimumab, and controls, this percentage was 15.5, 13.3, and 13.9 %, respectively. On the other hand, NAPSI improved more in infliximab-treated patients than in patients receiving etanercept and adalimumab .
The preliminary conclusions that can be drawn from these studies are that conventional therapies are less powerful and are slower-acting treatments for nail psoriasis than biologics, possibly with the exception of cyclosporine. No single biologic appears to be superior above another biologic. Evidence suggests that infliximab may act faster, but after 1 year of treatment these potential differences have vanished. On the other hand, the use of infliximab may result in higher percentages of onychomycosis.
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.
Psoralen Plus Ultraviolet A
For this treatment, you’ll first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin. This makes your skin more sensitive to light.
Your skin is then exposed to a wavelength of light called ultraviolet A . This light penetrates your skin more deeply than ultraviolet B light.
This treatment may be used if you have severe psoriasis that has not responded to other treatment.
Side effects include nausea, headaches, burning and itchiness. You may need to wear special glasses for 24 hours after taking the tablet to prevent the development of cataracts.
Long-term use of this treatment is not encouraged, as it can increase your risk of developing skin cancer.
Read Also: What Is The Best Skin Cream For Psoriasis
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.
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
Recommended Reading: Uv Light For Psoriasis At Home
Changes In Nail Shape Or Thickness
In addition to pitting, you might notice other changes in the texture of your nails. Psoriasis can cause lines called Beaus lines to form across your nails.
Weakness of the structures that support nails can cause your nails to crumble. Nails can also become thicker due to a fungal infection called onychomycosis, which is common in people with psoriasis.
Tablets Capsules And Injections
If your psoriasis is severe or other treatments have not worked, you may be prescribed systemic treatments by a specialist. Systemic treatments work throughout the entire body.
These medications can be very effective in treating psoriasis, but they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks. Before starting treatment, talk to your doctor about your treatment options and any risks associated with them.
If you’re planning for a baby, become pregnant or are thinking of breastfeeding, you should also speak to your doctor first before taking any new medicine to check it’s suitable for use during pregnancy or breastfeeding.
There are 2 main types of systemic treatment, called non-biological and biological .
Don’t Miss: Best Eye Cream For Psoriasis
How To Treat Nail Psoriasis Naturally
Psoriasis of the nails is probably the most challenging form of psoriasis to treat. Many treatments have been used and documented, but conclusive results have not been achieved yet. Therefore, the first nail psoriasis treatment to consider should be non-medical/ natural approaches of caring for your nails. Here are a few things you can do:
- Make sure you nails are short. It may seem simple and unnecessary, but a very strategic way of approaching the condition. Have you nails trimmed to the skin, and file them properly.
- Avoid using sharp objects when removing debris from the inside of the nail. Sharp objects aggravate Onycholysis in addition to making things worse. If you must remove the dirt, then it is wise to soak them in lukewarm soapy water for a few minutes. This should effortlessly get rid of the debris.
- Take considerable steps to protect your ailing nails from further damage, since any form of damage can worsen the condition. If at all possible, wear gloves to safeguard your nails from dirt and any unforeseen damage.
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
Don’t Miss: Best Bath Soak For Psoriasis
What Are The Causes Of Nail Psoriasis
The root cause of nail psoriasis is in the nail root which is the skin tissue of the nail bed from where the nail grows. Changes in the growth pattern of the cells in the nail root results in the development of the disease.
Family aggregation studies have linked psoriasis of the nails to genetic factors along with interactions with environmental influences.
Another cause for nail psoriasis is fungal infections like onychomycosis that cause thickening of the nails. This nail fungus produces the symptoms shown in psoriasis.
Living With Psoriatic Arthritis
Living with psoriatic arthritis is all about maintaining the right treatment plan. With the right treatment plan in place, you can live a life free of pain and inflammation. Most doctors prescribe a combination of therapies to patients with psoriatic arthritis. This can include drug therapies, home remedies, and lifestyle changes to increase mobility, treat psoriasis symptoms, and minimize joint pain.
Even though psoriatic arthritis is a lifelong, chronic, autoimmune disorder, this does not have to impact your quality of life. Get diagnosed early, have your doctor develop a treatment plan, and stick to it. These are the keys to living a healthy life with psoriatic arthritis.
You May Like: How Does Stelara Work For Psoriasis
Symptoms Of Nail Psoriasis
You’ll know you’re getting nail psoriasis when you see these changes in your fingernails or toenails:
- Color. Your nails may turn white, yellow, or brown. They may also have small red or white spots underneath.
- Surface appearance. You may get ridges or grooves in your nails, or pitting on the nail surface.
- Debris buildup. Chalky white material can gather under your nail, causing it to lift away from the skin. This can be painful.
- Thickening. About a third of people with nail psoriasis can also get a fungal infection that can cause your nails to get thick. They may also get brittle and break.
- Your nail may loosen or separate from the nail bed.
Some of these nail changes can make it hard to move your fingers and toes. You may also get tenderness and pain in your nails. This can make it hard to do things with your hands.
What Is The Outlook For Psoriatic Nail Disease
Psoriatic nail disease can be difficult to treat and there is no cure. It doesn’t usually grow out without treatment, so can continue to cause problems. The appearance of the affected nails can also sometimes cause distress.
The treatment of severe psoriatic nail disease is now improving with modern medicines.
Psoriatic nail disease can also be mild, not needing any treatment, and able to be hidden with nail varnish.
Don’t Miss: Can Psoriasis Go Away And Come Back
Ways To Treat Psoriasis Naturally
Guest writer for Wake Up World
Psoriasis is a common, chronic relapsing/remitting immune-mediated skin condition believed to be caused by an overload of toxicity through diet, some medications or our environment. It is characterized by red or white scaly patches and plaques, which usually itch. The condition affects up to five percent of the general population.
The causes of psoriasis are not fully understood, but a build up of toxins is known to be strongly correlated with most cases, especially for plaque psoriasis which is the most common type.
Not only are psoriasis flare-ups aggravating, but they make many people with the condition so self-conscious about their appearance that theyre reluctant to go out in public without ample covering. Probably most frustrating of all is that theres no magic formula to cure the condition indefinitely. You have to learn how to deal with flare-ups as they come, and take good care of yourself and your skin.
The good news is that is can be reversed through many different natural remedies, most of which should resolve the symptoms before ever requiring medication. Here are 12 effective natural remedies most found in your kitchen to help treat psoriasis discomfort, plus some simple everyday changes you can make to help prevent outbreaks.
Nail Infection Needs Treatment Too
A nail infection can develop if you have nail psoriasis. Because a nail infection can look a lot like nail psoriasis, its important to find out if you have an infection. Testing, which usually consists of scraping the nail, can find an infection. If you have a nail infection, treatment can get rid of it.
Also Check: Can You Get Psoriasis In Your Belly Button
What Are Nail Psoriasis Symptoms And Signs
Usually, people who have nail psoriasis also have skin symptoms, too. If someone has psoriasis of the nails but does not have skin symptoms, the condition may be difficult for a doctor to diagnose, since the signs of psoriasis of the nails resemble those of fungal infection of the nails. It is important to inform the doctor if there is a family history of psoriasis.
The nail unit is made up of a nail plate, nail bed, hyponychium, nail matrix, nail folds, cuticle, anchoring portion, and ends of the finger bones. See each of these structures in images 1-2.
Someone might notice the following signs with psoriatic nails:
Nail psoriasis can also occur together with fungal infections of the nail and inflammation of the skin around the edges of the nail .
Articles On Psoriasis Locations
If you have psoriasis and you notice some changes in your nails, there are many treatments you can turn to for help.
Nail psoriasis alters the way your toenails and fingernails look. They may get thick, develop pinprick holes and change color or shape. They also can feel tender and hurt.
You can treat these problems with medicine. Cosmetic repairs can make your nails look better.
Recommended Reading: What Age Can You Get Psoriasis
Deterrence And Patient Education
Nail psoriasis is a chronic disease process, treatment may be prolonged, and education of patients is an essential part of management. The treatment is prolonged due to a slow nail growth pace, which leads to a prolonged course of treatment. Proper communication with the patient may encourage reasonable perceptions of treatment outcomes, and it may facilitate therapy adherence. Patients need to follow gentle hand and foot care measures that may help to decrease the symptoms. These general measures include the regular application of emollients, regularly trimming of the nails, keep them dry and protection from trauma to prevent Koebner phenomena. In addition, they need to take photographs of nails periodically as these pictures would help to assess the treatment response.
Grenz Ray Climatotherapy Visible Light Goeckerman And Pulsed
Evidence is insufficient to recommend grenz ray therapy for the treatment of psoriasis.
Sufficient evidence exists to recommend climatotherapy for the treatment of psoriasis.
Evidence is insufficient to recommend the use of visible light as a more effective treatment for psoriasis, except in nail psoriasis.
Sufficient evidence exists to recommend Goeckerman therapy for the treatment of psoriasis.
Pulsed-dye laser can be considered for nail psoriasis.
You May Like: Severe Psoriasis All Over Body
How Is Nail Psoriasis Diagnosed
Nail psoriasis is usually diagnosed clinically in a patient with psoriatic arthritis and/or cutaneous psoriasis.
The severity of nail psoriasis can be estimated using the Nail Psoriasis Severity Index in which each nail is divided into quadrants and scored for clinical signs to come up with a numerical score.
Nail clippings for fungal microscopy and culture should be taken as onychomycosis may precede or complicate psoriatic nail dystrophy, and immunosuppressive medications may be used in treatment.
A proximalnail matrix biopsy is occasionally needed to confirm the diagnosis of nail psoriasis, particularly in the absence of signs of psoriasis elsewhere or where only a single nail is affected and a tumour cannot be excluded by other means. Biopsy can lead to permanent nail deformity.
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.
Also Check: How To Remove Psoriasis Black Marks
Causes And Changes Of Nail Pitting Psoriasis
Psoriasis is not a contagious disease. Therefore, the cause of the formation of psoriasis on the nails is not clearly known. From a medical point of view, the condition is attributed to environmental, immunologic, and inherited risk factors. Research states that psoriasis is a genetic disease, which can be passed to a sibling. The risk of inheriting the ailment increases if both parents are susceptible to psoriasis. The nails are part and parcel of the skin. Thus, it does not come as a surprise that the nails are affected. The genetic factor is arguable. In fact, no one has any idea why some get it and others dont.
Unlike other forms of psoriasis, there are considerable and conceivable changes brought by nail psoriasis. The first and most notable change is nail pitting. In this case, the surface of the nails forms small pits that resemble a thimbleâs surface. The number of the pits does usually vary from a single pit to a dozen. The second change is Onycholysis. At this stage, the nail separates from the nail bed, developing a gap. It starts as a yellowish or whitish cover at the nail tip, which normally goes down to the cuticle. You can best understand this from nail psoriasis pictures.
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
Also Check: What Causes Scalp Psoriasis To Flare Up