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Treatment For Nail Psoriasis Uk

Steroid Creams Or Ointments

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Steroid creams or ointments are commonly used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching.

Topical corticosteroids range in strength from mild to very strong. Only use them when recommended by your doctor.

Stronger topical corticosteroids can be prescribed by your doctor and should only be used on small areas of skin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning.

Narrowband Ultraviolet B Phototherapy

For adults with generalized plaque psoriasis, the recommended NB-UVB phototherapy starting dose should be based on the minimal erythema dose or it should be determined based on a fixed-dose or skin-phototype protocol.

For adults with generalized plaque psoriasis, a treatment phase of thrice-weekly dosing of NB-UVB phototherapy is recommended.

For adults with psoriasis, treatment with short-term psoralen plus ultraviolet A monotherapy is more effective than NB-UVB.

Owing to its increased safety, higher convenience, and lower cost, NB-UVB is preferred over PUVA monotherapy for psoriasis in adults, even though it is less effective.

In adults with generalized plaque psoriasis, NB-UVB is recommended over broadband ultraviolet B monotherapy.

Treatment with NB-UVB monotherapy is recommended for guttate psoriasis patients, regardless of their age.

For appropriate patients with generalized plaque psoriasis, home-based NB-UVB phototherapy is recommended as an alternative to in-office NB-UVB phototherapy.

Treatment with NB-UVB phototherapy is recommended for pregnant patients who have guttate psoriasis or generalized plaque psoriasis.

As a measure to possibly improve efficacy, NB-UVB phototherapy can be safely augmented with concomitant topical therapy using retinoids, vitamin D analogues, and corticosteroids.

Oral retinoids can be combined with NB-UVB phototherapy in appropriate patients with generalized plaque psoriasis if they have not responded adequately to monotherapy.

What Makes Psoriasis Worse

The cause of psoriasis is not fully understood but it is known to be related to the activity of the immune system where the immune system attacks healthy skin cells. It is also known that genetics does play a role as psoriasis can run in families. Many peoples psoriasis is started by or is made worse by certain factors known as triggers. Some known triggers are:

  • Stress
  • Drinking a lot of alcohol
  • Damage to the skin such as sunburn, or a cut, scrape or insect bite
  • Hormonal changes especially in women during puberty or the menopause
  • Certain medicines such as lithium, some anti-malarial medicines, anti-inflammatory medicines including ibuprofen, ACE inhibitors used to treat high blood pressure and beta- blockers used to treat heart failure
  • Streptococcal throat infections.

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What Will Happen During My Consultation

During your consultation, your dermatologist will speak to you about your symptoms and when they started. They will also try to identify any patterns, such as when they might be worse. It is best to come prepared, so you are ready to answer questions about when your symptoms began and exactly what they consist of, particularly if your symptoms are less than normal when you book your appointment.

They will examine the affected area and will be able to diagnose exactly which type of psoriasis you have, or what is causing your skin to react. We are able to treat all types of psoriasis and skin conditions. After we have made a diagnosis, we may refer you for further testing such as allergy patch testing or prescribe medications, light therapy, topical creams and home care instructions.

Our aim is to make your symptoms as minimal as possible, with the most effective treatment plan for your condition.

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Although psoriasis is a chronic condition, we aim to significantly reduce your symptoms. When managed well with the correct treatment plan, we may be able to eradicate them altogether.

Our aim is to get you the best possible result and leave you feeling confident that you have your psoriasis under control. Our team is always on hand to answer any questions you might have about your treatment plan.

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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.

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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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.

What Does Psoriasis Look Like

Nail Psoriasis, Symptoms, Treatments and More

The skin changes of psoriasis are well defined and slightly raised pink or red areas with silvery-white scales. Many people have just a few plaques but some individuals with moderate to severe psoriasis may have several plaques covering large areas of their body.

Several patterns of psoriasis are recognised:

  • Chronic plaque psoriasis is the most common type of psoriasis. Plaques of psoriasis are usually present on the knees, elbows, trunk, scalp, behind ears and between the buttocks although other areas can be involved too.
  • Guttate psoriasis consists of small plaques of psoriasis scattered over the trunk and limbs. It can be caused by a bacteria called Streptococcus which can cause throat infections.
  • Palmoplantar psoriasis is psoriasis affecting the palms and soles. Psoriasis may appear at other sites too.
  • Pustular psoriasis is rare type of psoriasis where the plaques on the trunk and limbs are studded with tiny yellow pus filled spots. It can be localised or generalised and can flare rapidly necessitating hospital admission for treatment.
  • Erythrodermic psoriasis is an aggressive rare form of psoriasis which affects nearly all of the skin and can sometimes require hospital admission for treatment.

Nail psoriasis is present in about half of people with psoriasis. The features of nail psoriasis are:

  • Pitting and ridging of the surface of the nail
  • Salmon pink areas of discolouration under the nail
  • Thickening and yellowing of the nails.
  • Complete nail destruction.

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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.

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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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.

Skin: Condition: Infomation Internal Treatments

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  • Tablet options include acitretin , ciclosporin , methotrexate , and in some hospitals fumaric acid esters and apremilast.
  • Injectable treatments for psoriasis include etanercept, adalimumab, infliximab, ustekinumab, secukinumab, ixekizumab and guselkumab. Other new tablet and injected treatments are being developed in clinical studies at present.
  • Blood tests may be recommended by your GP or dermatologist. If you are considering tablet or injection treatment for your psoriasis, then blood tests will be needed before and during treatment.

Further details of these treatments can be found in the Treatments for moderate and severe psoriasis and individual drug patient information leaflets.

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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.

Skin: Condition: Infomation Phototherapy:

Two types of light are used: narrowband ultraviolet B light and ultraviolet A light . The latter requires a sensitiser, known as a psoralen that can be taken as a tablet or added to a bath prior to treatment.

Further information on phototherapy is available in the following information leaflets: Treatments for moderate and severe psoriasis and ).

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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.

A Range Of Therapies Are Available For The Treatment Of Psoriasis

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Psoriasis is a common skin problem, which follows a chronic course interspersed with periods of remission.1 The condition is not infectious and does not scar the skin.2 It affects about 2% of the population and occurs equally in men and women, at any age. There is a hereditary component: a child who has one parent with psoriasis has approximately a 1 in 4 chance of also developing the condition.2 There is no cure for psoriasis but symptoms can be controlled.2 Many patients can be managed in primary care, but a significant number will benefit from treatments that are provided or initiated in secondary care.

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How Is Psoriatic Nail Disease Diagnosed

The diagnosis of psoriatic nail disease is usually made by the appearance of the affected nails. Sometimes scrapings from under the nail, and nail clippings, are sent to the laboratory to be tested for fungal infection of the nail, which can sometimes look like psoriatic nail disease.

Occasionally, a sample of nail is needed to confirm the diagnosis.

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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.

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What Causes Onycholysis

The exact cause of onycholysis is not known, but it is thought that autoimmune issues have a correlation to the inflammation.There are also a number of factors that are thought to contribute to this condition for example, things like repetitive trauma to the nails is thought to cause onycholysis. This can even be something as simple as tapping nails on a keyboard or countertop, which is why this condition and the accompanying nail bed damage is often seen in women with long nails. It can sometimes be the case that overzealous grooming pushes bacteria beneath the nail, which may cause the onset of this condition.

What Are The Symptoms

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The severity of symptoms can vary a great deal from person to person but it usually comes and goes in phases, worsening and causing problems for a few weeks or months and then improving or disappearing altogether for a while. For some people, psoriasis is a minor irritation whilst for other people it can be a huge problem seriously affecting their life because of the extent of the irritation, complications that can come with bad cases and embarrassment at the appearance of the skin. Such complications include cracking and bleeding of the skin and infections in the skin. About 30% of people with psoriasis will develop psoriatic arthritis where joints become swollen, painful and stiff. If you think you have psoriasis you should always see your GP.

Once you have been diagnosed by your GP the Pharmacy2U Online Doctor service can offer convenient access to prescription strength Psoriasis medication. Act now and start a convenient and confidential Psoriasis consultation with our UK registered GP.

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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.

Where Can Patients Find Support For Nail Psoriasis

Education is one of the foundations for managing this chronic and typically relapsing disorder. People with psoriasis should be familiar with the treatment options in order to make proper informed decisions about therapy. The National Psoriasis Foundation is an excellent organization that provides support to people with psoriasis.

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Healthy Eating And Exercise

People with psoriasis have a slightly higher risk of developing diabetes and cardiovascular disease than the general population, although it’s not known why. Regular exercise and a healthy diet are recommended for everyone, not just people with psoriasis, because they can help to prevent many health problems.

Eating a healthy, balanced diet and exercising regularly can also relieve stress, which may improve your psoriasis.

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