When Do Nail Symptoms Occur
PsA may not present the same way for every person, but it typically always develops in stages.
In its preclinical stage, psoriatic inflammation may only cause fatigue, heel pain, and joint pain. At this time, doctors may not yet be able to identify the condition as PsA.
Once the condition progresses a little, nail changes can begin to occur. These include pitting, discoloration, softness, holes, and dactylitis, or the swelling of the toe or finger. This may still be an early phase of the condition.
As the condition progresses even further, these and other symptoms may get worse and progress to severe damage to the bones.
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.
Common Clinical Manifestations Of Nail Matrix Psoriasis Include
Pitting is the commonest manifestation of nail psoriasis. Pits affect the fingernails more commonly than the toenails. They are superficial depressions in the nail plate that indicate abnormalities in the proximal nail matrix . Psoriasis affecting the proximal nail matrix disrupts the keratinization of its stratum corneum by parakeratotic cells. These cells are exposed as the nail grows and are sloughed off to form diffuse and coarse pits. The length of a pit is suggestive of the length of time, the matrix was affected by the psoriatic lesion and a deeper pit is suggestive of involvement of intermediate and ventral matrix along with the dorsal matrix. Pitting may be arranged in transverse or longitudinal rows or it may be disorganized. They may be shallow or large to the point of leaving a punched out hole in the nail plate known as elkonyxis. More than 20 fingernail pits per person are suggestive of a psoriatic etiology and more than 60 pits per person are unlikely to be found in the absence of psoriasis.
Pitting affecting the fingernails
Transverse grooves are formed in the same way as pits when the psoriatic lesion affects a wider area of the nail matrix .
Transverse grooves on the nail plate in a patient with psoriasis
Nail plate thickening and crumbling
It suggests an extensive involvement of the entire nail matrix by the psoriatic process .
Nail plate thickening and crumbling resulting in complete nail dystrophy
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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.
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.
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How To Treat Nail Psoriasis Medically
The most popular medical nail psoriasis treatment is the use of topical steroids. As far as topical steroids are concerned, you are supposed to massage a steroid ointment into the nail plate. The risk associated with this treatment is the thinning of the cuticle because of the fine blood vessels. Also, results are not consistent. Steroids can be injected under the nails. This method is normally painful and the doctor may be required to inject you with a local anesthetic prior to the procedure. Not highly recommended, though.
Nail removal is the next medical approach. The most painlessly way of removing damaged nails involves a number of things. To begin with, the nails have to be applied with urea . What happens is that the nails will loosen up and they can effortlessly be unwrapped off. Your physician can use surgery or X-ray to remove the nails. The only problem with this method is that the nails may regrow deformed.
The next medical treatment for nail pitting psoriasis is systemic treatment. This option is considered when the condition has worsened. Usually, the patient will have difficulty using his or her feet and hands. The patient may be completely unable to walk or using the hands to do anything productive.
Treatment Of Nail Psoriasis
Nail disease is usually overlooked in the management of psoriasis, with skin involvement being the primary concern. Also, treatment of nail psoriasis is a big challenge for a dermatologist because of the following reasons:
Poor drug delivery: the matrix pathology is hidden by the proximal nail fold and the nail bed changes are protected against treatment by the overlying nail plate and nail bed hyperkeratosis, making delivery of drug to the affected site very difficult.
Slow rate of nail growth attributes to a longer duration of treatment required, leading to a questionable long-term compliance by the patient.
Keeping in mind the potential significant toxicities of the various systemic agents advocated for psoriasis, the use of systemic agents is not generally advisable for treating nail psoriasis alone and is recommended for cases with coexistent severe skin or joint disease or in patients with extensive or recalcitrant nail psoriasis.
Also, despite the recognized burden of nail psoriasis, there is a dearth of good-quality evidence for the management of nail psoriasis. A recent systematic review on treatment options for nail psoriasis, published in January 2013, highlighted the fact that the quality of trials done so far is generally poor and the data available is insufficient to advocate a consistent treatment approach or algorithm for the management of psoriasis.
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For Best Results From Treatment
Treating nail psoriasis can be a challenge. It often takes time to treat. To get results, you need to treat your nails as directed and for as long as directed. Some patients need to try a few treatments to find one that works.
The right nail care can help you get the best results from treatment. Youll find out what dermatologists recommend at: 7 easy-to-follow nail care tips that can reduce nail psoriasis
ImagesImages used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol 2013 69:249.
ReferencesCrowley JJ, Weinberg JM, et al. Treatment of nail psoriasis: Best practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015 Jan 151:87-94.Dogra A, Arora AK. Nail psoriasis: The journey so far. Indian J Dermatol. 2014 Jul 59:319-33.Lin YK, Chang YC, et al. A Chinese herb, indigo naturalis, extracted in oil used topically to treat psoriatic nails: A randomized clinical trial. JAMA Dermatol. 2015 Jun 151:672-4.Manhart R, Rich P. Nail psoriasis. Clin Exp Rheumatol. 2015 Sep-Oct 33:7-13.van der Velden HMJ, Klaassen KMG, et al. Fingernail psoriasis reconsidered: A case-control study. J Am Acad Dermatol 2013 Aug 69:245-52.
All content solely developed by the American Academy of Dermatology
The American Academy of Dermatology gratefully acknowledges the support from Amgen and .
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.
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Conditions With Similar Symptoms
Nail psoriasis can resemble a fungal infection, such as onychomycosis. This also causes the nails to thicken. Moreover, onychomycosis often occurs alongside nail psoriasis. This can make diagnosis difficult.
Getting a correct diagnosis is important because the treatment for a fungal infection is different from the treatment for nail psoriasis. Anyone with psoriasis and changes in their nails should make sure that their doctor is aware of their psoriasis.
Nail psoriasis does not always cause physical pain, but some people may find it unsightly, and it can cause embarrassment. Treatment can prevent it from worsening.
- topical medicines, such as creams applied directly to the nails
- systemic medications, which affect the whole body
- intralesional therapies, which involve a doctor injecting medication into the nail bed
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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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.
What Are The Main Signs And Symptoms Of Nail Psoriasis
Nail psoriasis canrange from mild to severe, and it is easy to misdiagnose as a fungal infection.Any of the following signs may suggest nail psoriasis:
- Loss of the nail’s usual healthy look, shape and feel
- Discolouration of the nail
- Pitting across the surface of the nail
- Nails that split or crumble easily
- Thickening of the nail
- Nails that lift or detach themselves from the nail bed – known as onycholosis
Nail psoriasis is not just a cosmetic problem, and should be appropriately treated by a healthcare professional such as a doctor or nurse. In moderate to severe cases, nail psoriasis can be painful and make using the hands and feet difficult. Hands and feet are easily seen, and people with nail psoriasis may find this distressing and try to hide their hands and feet, or avoid situations in which they can be seen.
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What Are Your Nail Psoriasis Treatment Options
Many people who have psoriasis also experience changes in their fingernails or toenails. But there are treatments that can help.
Nail psoriasis is the term for changes in your fingernails and toenails that occur as a result of having the autoimmune disease psoriasis. According to the National Psoriasis Foundation, up to 55 percent of people with skin psoriasis also have nail psoriasis.
While it’s not a life-threatening condition, nail psoriasis can affect your quality of life, since it may cause you discomfort and affect your self-esteem. It may also be a clue that you’re at greater risk of developing psoriatic arthritis. Although it cannot be cured, nail psoriasis can be helped with treatment.
Should You Take Psoriasis To The Nail Salon
Psoriasis could affect your nails, but a safe manicure and pedicure may help you feel better about your hands and feet.
For some people living with psoriasis, showing off painted fingers and toes may seem out of the question. From nails that are pitted, thickened, and discolored to ones that are separated from the nail bed, it can be embarrassing.
If you treat psoriasis, the appearance of your nails will improve. Depending on the severity of your symptoms, treatment may involve topicals, , or biologic drugs. In a study published in March 2010 in the journal Archives of Drug Information, researchers found that the drug efalizumab was more effective in treating nail psoriasis than topical treatments and light therapy.
Even if the treatment is effective, you still may want to polish your nails to make them look better and to help you feel better about yourself. But is it safe to get a pedicure or manicure when you have psoriasis?
Most definitely, says Marlene Reid, doctor of podiatric medicine with Family Podiatry Center in Naperville, Illinois, and past president of the American Association for Women Podiatrists. Its not going to help, but its not going to make it worse, either, she says. Getting polish to cover up is fine.
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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
Beyond The Skin And The Nail
Nail psoriasis is considered a precursor of a severe inflammatory joint disorder. There is a positive association between nail psoriasis and the severity of joint involvement. Nail psoriasis is also correlated with enthesitis, polyarticular disease, and unremitting progressive arthritis. High-resolution magnetic resonance imaging studies have found that psoriatic arthritis related DIP joint inflammatory reaction is very extensive which frequently involves the nail matrix and often extends to involve the nail bed. This is mainly due to the attachment of fibers of ligaments and tendons of DIP joint close to the matrix. The presence of joint or nail symptoms may indicate a severe form of psoriasis, and this will affect how the disease is managed. It is important, therefore, for dermatologists to be aware of the early symptoms of psoriatic arthritis, particularly in patients with nail psoriasis, in order to avoid progressive joint damage.
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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.
When To Contact A Doctor
Anyone with PsA who is experiencing new nail symptoms may wish to contact a doctor. Likewise, anyone who is unsure about whether their treatment is working can ask a doctor about other treatment options.
The nails grow slowly, so results from any treatment can take time to show up. It is vital to be patient with oneâs treatment regimen and to report any positive or negative changes to a doctor for review.
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When To See A Doctor
Nail psoriasis is not contagious, and treatment can reduce or help control the symptoms.
If the nails show symptoms of psoriasis or a fungal infection, see a doctor. This is especially important for people who already have a type of psoriasis.
A person may have to try several treatments before finding one that works.
Symptoms can take time to improve, and they may take up to a year to clear. One reason for this is that the nail plate grows very slowly. The symptoms may also return at a later date.
With new drugs appearing on the market, more effective treatments for nail psoriasis may be on the horizon.