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.
Miscellaneous Systemic Therapies: Fumaric Acid Esters Sulfasalazine And Leflunomide
Fumaric acid esters , sulfasalazine, and leflunomide have also been reported to be effective in nail psoriasis however, based on the current knowledge, they cannot be advised for this indication. FAEs have been used for the treatment of chronic PP since 1959. The commercially available form, containing mainly dimethylfumarate, is currently a first-line systemic therapy for severe chronic PP in several European countries it is not effective in PsA. The general opinion is that it has little efficacy in nail psoriasis, but one case has been reported in which it was effective both on nail bed and nail matrix psoriasis . Side effects are frequent in patients using FAEs, such as episodes of flushing, abdominal pain, and a decrease in lymphocyte count.
Sulfasalazine is an aminosalicylate used as a traditional disease-modifying antirheumatic drug for the treatment of peripheral involvement in PsA. Sulfasalazine is metabolized by gut flora into sulfapyridine and 5-aminosalicylic acid, which act as anti-inflammatory agents. The role of sulfasalazine in cutaneous psoriatic lesions and nail psoriasis is not generally accepted. One case has been reported on the use of sulfasalazine in the treatment of psoriatic nail lesions . After 3 months, nail lesions started to recede and disappeared progressively. No other cases have been reported in literature.
What Treatments Are Available
Mild nail disease which isn’t causing discomfort does not need any treatment. If the nail disease is severe and causing problems then your doctor may refer you to see a skin specialist for advice and treatment. Unfortunately treatment of psoriatic nail disease is difficult and not always successful.
Treatments for nail psoriasis include:
- Treatments applied to the nail, which include steroids, salicylic acid, calcipotriol or tazarotene. Local treatments applied to the nail are often not very effective but are worth trying. If the nail is lifting off then strong steroid scalp application can be trickled under the nail.
- Antifungal treatment – this may be required for fungal nail infection if this is also present.
- A steroid injected into the nail – this may be effective for some types of nail psoriasis but it is painful.
- Light therapy – psoralen plus ultraviolet light A treatment is effective for some types of nail psoriasis but not for pitting of the nail.
- Removing an affected nail – this can be done by applying a special type of ointment and then covering the nail for seven days. Otherwise the nail can be surgically removed using local anaesthetic.
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What Are Medications For Nail Psoriasis
A doctor may prescribe any of the following medications:
- Creams or ointments to rub on and around the nail, including steroid, topical vitamin A or vitamin D derivatives , antimetabolite drugs
- Steroids can applied to the skin under the nail or cortisone injections may be given under the nail injection under the nail may be more effective than when steroids are applied in cream or ointment form.
- PUVA: This therapy is a combination of the prescription medicine, psoralen, and exposure to UVA ultraviolet light.
- Systemic therapy may be appropriate if you have both skin and arthritis symptoms or if the skin and nail symptoms are severe or persisting. Systemic therapy is medication that spreads throughout the body. It is often in pill or injectable form, including methotrexate or cyclosporine tablets, and the injectable biologics etanercept , adalimumab , ixekizumab , secukinumab , and ustekinumab as well as infusible infliximab . An oral medication for both plaque psoriasis and psoriatic arthritis is apremilast .
See the article Understanding Psoriasis Medications for more information.
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.
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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.
Complications Of Toenail Psoriasis You Should Be Aware Of
As noted above, toenail psoriasis can lead to a condition known as onycholysis, in which the nail detaches from the nail bed. This can allow bacteria access to the nail bed, leading to infection.
Subungual hyperkeratosis, the accumulation of a chalky substance under the nail, can cause the nail to become raised, which may be painful and can cause difficulty walking normally or wearing shoes.
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Miscellaneous Topical Therapies: Allopurinol Intralesional Methotrexate Colloidal Silicic Acid Indigo Naturalis Extract
Allopurinol, intralesional methotrexate, colloidal silicic acid, and indigo naturalis extract have been investigated in nail psoriasis but are not routinely used in clinical practice because of insufficient data, poor study results, or lack of registration. Allopurinol is a purine analog and an often-prescribed urate-lowering drug for the management of gout. It inhibits xanthine oxidase, a key enzyme involved in the oxidation of hypoxanthine and xanthine, reactions that ultimately result in the production of uric acid. Case reports from the early 1970s suggested a positive effect of allopurinol on PP. One placebo-controlled study investigated allopurinol in PP and nail psoriasis . Allopurinol was found to be no more effective than placebo after 8 weeks of treatment.
Methotrexate is a folic acid analog that irreversibly binds to dehydrofolate reductase and blocks deoxyribonucleic acid synthesis. It is usually taken orally or administered by injection and has several indications, including psoriasis. Intralesional use of methotrexate may limit the dose, and hence the side effects, but is not a generally accepted treatment in nail psoriasis. Saricaoglu et al. reported a 26-year-old women who was treated with methotrexate 2.5 mg every week into the proximal nail fold on each side of the nail . Subungual hyperkeratosis and pitting had improved after six treatments.
How Do You Treat Nail Psoriasis
There is no complete cure for nail psoriasis one can only use a prolonged treatment regimen in order to keep this fingernail disorder under control. Psoriasis treatment includes the following:
- Topical creams: These are an array of creams or gels that can be directly applied to the nails without any supervision. The ointments contain extracts of Vitamin A, Vitamin D and Calcipotriol . The only limitation with this treatment would be that the contents of the cream do not reach the nail matrix as the cuticle forms a thick barrier. Over months of treatment, the barrier thins down.
- Antifungal treatment: Antifungal treatment is prescribed when nail psoriasis worsens due to a fungal infection.
Regardless of the type of treatment option, it is important to stay patient. These treatment plans work on the new nail and the process of outgrowing the defected nail takes at least a year for fingernails and twice as much for toe nails.
Psoriasis of the nails affect the dexterity and overall functioning of ones hands. It is always better to take simple steps to prevent this nail disorder than battle it later.
- Keep your nails trimmed short.
- Wear cotton or rubber gloves while performing chores that may result in nail wreckage.
- Apply moisturizers on the nail cuticle to strengthen the root cells and to deplete the chances of nail dystrophy.
- Soak toenails in a warm water bath for 10 minutes at least once a month. This ensures that no debris build-up under the nails.
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Are There Home Remedies For Nail Psoriasis
There are no home remedies to cure nail psoriasis. In areas where the nail has loosened, gently trim the nail back to the skin where it is connected. This will allow medications to work better. All nail care must be very gentle. Vigorous nail care and attempts to remove debris beneath the nails can cause psoriasis to flare and worsen. Attempt to avoid injuring the nails so that the nail doesn’t loosen more and so that the area doesn’t become infected.
Nail polish is safe to use and can hide discoloration. It may also help to reduce the appearance of surface irregularities. Nail polish should be removed before medical examination of the nails.
What Treatments Are Available For Nail Psoriasis
There are many treatments for nail psoriasis. Your treatment plan may include one or more of the following.Treatment you apply to the nails: This can be helpful for mild or early nail psoriasis. Nails grow slowly, so youll need to apply these treatments for several months, often once or twice a day. Because nail psoriasis can be stubborn, you may need to use more than one treatment. Sometimes, two medicines are combined to give you a faster response.
Treatment that you apply to your nails includes the follow.
A potent or very potent corticosteroid: This can be helpful for most signs and symptoms of nail psoriasis. Its safe to use this medicine once or twice a day for up to nine months.
Calcipotriol: In one study, researchers found this to be as effective as a potent corticosteroid at treating the buildup beneath the nail.
Tazarotene: This treatment can be especially helpful for treating pitting, a separating nail, and discoloration.
If you need stronger treatment, your dermatologist may recommend treatment given in a dermatologist office or clinic. This treatment may include one of the following.
Psoriasis medicine that can help clear the skin and nails includes:
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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 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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Management Of Nail Psoriasis
The choice of treatments depends on clinical presentation, as well as patient-related factors. Most patients have only mild nail psoriasis without signs of PsA or severe PP. These patients may profit from topical treatment, while systemic treatment is indicated in patients with severe nail psoriasis, major impact on QoL, or concomitant moderate to severe psoriatic skin lesions. Systemic therapy should also be favored if concomitant PsA is evident. The choice of treatments further depends on patient factors, including age, experienced burden of disease, accompanying diseases and therapies, individual patient preferences, and the risks of treatment.
Clinical Features Of Nail Psoriasis
Nardo Zaias, in 1969, firstly described the pathophysiology of nail psoriasis. The nail bed, nail matrix, hyponychium, and nail folds can be affected by nail psoriasis. The most observed forms are psoriasis of the nail matrix, nail bed, and nail fold. Pitting, leukonychia, red spots of the lunula, transverse grooves , and crumbling of the nail plates are the typical signs of psoriasis of the nail matrix. Oil-drop discoloration, splinter hemorrhages involving the distal third of the nail plate, subungual hyperkeratosis, and/or detachment of the nail plate from the nail bed are the characteristic marks of the nail bed involvement. Psoriasis of the periungual region is characterized by paronychia.
The severity of nail psoriasis is evaluated by Nail Psoriasis Severity Index which is a numeric, reproducible, objective, and simple tool. According to this index, each nail is divided into four quadrants, each of which is assessed for the presence of any signs of psoriasis in the nail matrix such as pitting, leukonychia, red spots in the lunula, nail plate crumbling and nail bed as oil-drop discoloration, onycholysis, hyperkeratosis, and splinter hemorrhages. This scale is used to evaluate the severity of nail bed psoriasis and nail matrix psoriasis based on the area of involvement in the nail unit. NAPSI is useful during clinical trials for assessing response to treatment of patients with psoriatic nails.
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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
Dab Some Tea Tree Oil
Tea tree essential oil has antibacterial, antifungal, and antiseptic properties that can fight fungal and bacterial infections of the nails. This essential oil is also rich in terpinen-4-ol, which is an anti-inflammatory agent and helps reduce the pain.
How to use:
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What Does Your Patient Need To Know At The First Visit
Patient education is important initially. There are several causes for nail dystrophy. Oftentimes, when patients present, they believe that they have onychomycosis. Therefore, it is important to counsel individuals with potential nail psoriasis and to discuss the differential diagnosis of the condition.
Nail matrix psoriasis demonstrating pitting and onycholysis. Photograph courtesy of Antonella Tosti, MD . Reprinted with permission from Cutis. 2013 92:129-135.
The presence of psoriasis on other areas of the body and the absence of fungal infection on the soles of the feet and in between the toes increases the likelihood of nail psoriasis. The most accurate test to perform is a nail clipping with subsequent periodic acidSchiff stain. It is important to remember, however, that nail psoriasis and fungal infection of the nail can coexist.
Once the diagnosis of nail psoriasis is established, it is important to review gentle care of the nails. A thorough discussion of therapeutic options is helpful. Patients also should be advised that the presence of nail psoriasis can increase the likelihood of the development of psoriatic arthritis.
Medications That Treat Your Skin
Here are some common ways to treat psoriasis on the hands and feet and relieve your symptoms.
In addition to moisturizers, mild soaps, and soap substitutes, your doctor may recommend:
- Coal tar products, like creams, gels, or ointments, to slow skin growth and ease itchy, inflamed, or scaly skin
- Salicylic acid, a peeling agent that softens or reduces thick scales
- Corticosteroids, often creams and ointments
Combinations of these often work better than one treatment alone. Sometimes doctors suggest alternating or using topical corticosteroids with a type of vitamin D called calcipotriene. This medicine should not be used on the face, so be sure to wear gloves when applying to your hands and feet in order to avoid getting it on your face later.
Your doctor might have you use a corticosteroid under a type of dressing called hydrocolloid occlusion. This filmy layer bonds to the cream, helps keep skin moist, and can be worn for several days. Wetting your skin, rubbing on a corticosteroid cream and sealing it in with plastic wrap overnight also is helpful.
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