What Your Nails Can Tell You About Psa
When it comes to psoriatic disease, the nails also can be a sign that something even bigger could be brewing.
Evan L. Siegel, M.D., a rheumatologist who shares a practice with Prussick in Rockville, Maryland, believes the main point to take away is that for patients with psoriasis, nail involvement is a risk factor for developing PsA.
âA person who has nail psoriasis has a threefold increased risk for developing PsA, which translates to around 80 percent of people with PsA having nail involvement,â says Siegel.
He also explains that paying attention to what your nails are trying to tell you can mean the difference between minimal and serious, irreversible damage to the joints. âWhen treating skin psoriasis, the skin that grows back is typically normal, healthy skin,â he says. âBut with PsA, once the damage is done, it is permanent.â
Siegel also echoes Prussick about the Koebner phenomenon: He believes trauma to the nail, surrounding skin and joints may play a role in the development of PsA. Siegel says inflammation below the nail matrix in the distal interphalangeal joint can contribute to nail symptoms. Protecting these areas from injury and trauma and from stress can help prevent the progression of nail psoriasis and heal the nail, Siegel says.
The Nutritionist And Vitamin D Supplementations
Supplements are the most important determinant of variation in vitamin D intake A number of studies showed that the daily intake of vitamin D was higher in adults using vitamin D supplements than in those without vitamin D supplementations . Most nutritionists recommend the use of vitamin D3 to treat and prevent vitamin D deficiency, because several studies indicating a higher efficacy for vitamin D3 in raising serum 25D concentrations when compared to vitamin D2 . Although a significant inter-individual variation exists, due to different variables including body weight, sunlight exposure and calcium intake, it has been calculated that supplementation of 1000 IU of vitamin D3 daily leads to an approximate increase in 25D levels by 1020 ng/mL , . Findings from randomised placebo-controlled trials conducted during the winter have shown that each 1 mg of supplemental vitamin D is associated with an increase in serum 25D of between 0.7 nmol/L and 2 nmol/L .
Treatments For Nail Psoriasis
The same treatments you get for skin psoriasis can also treat your nail psoriasis. Because your nails grow slowly, it can take time before you see any improvements in the newly grown parts of your nail.
The treatments for nail psoriasis include:
- Ultraviolet light is used to treat skin psoriasis and may also be useful in nail psoriasis. The treatments usually take place in a doctor’s office or a clinic.
- Medicines that work throughout your body. Your doctor may call these “systemic medications.” Some examples are:
If your nails are thick, the medicine you apply may have a hard time getting inside. Gels or ointments that contain urea can help thin them.
Your doctor may also prescribe a nail lacquer that hydrates and strengthens your nails. You apply it every day in the same way you put on nail polish.
- Corticosteroid injections. These are put under your nail surface every 2-9 months. Your doctor will numb the area or use a nerve block to reduce pain.
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Warm Water And Oil Bath To Fix Psoriasis Nails
One of the most effective over-the-counter treatment for nail psoriasis is to use cold pressed Jamaican roasted castor oil . This is an effective, and easy home treatment method. Fill a big bowl or tray with warm water. Add 30 ml of cold pressed Jamaican roasted castor oil to it. Soak your hands or feet in this for 30 minutes. This helps to soften nails and scales around it. Trim nails and then apply a good beeswax moisturizer to each of the nails.
You can also use various warm vegetable oils like cold pressed coconut oil, sunflower oil, sesame oil, olive oil etc. Adding essential oils like neem oil, tea tree oil or lavender oil helps to increase medicinal property of the oil bath.
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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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
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
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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.
The Dermatologists Point Of View
Patients suffering from psoriasis present a broad range of clinical phenotypes. Psoriatic lesions are classified into plaque, guttate, pustular, and erythrodermic types according to clinical features, especially regarding lesions size and distribution . Disease onset may occur at any age, including childhood, with two peak age ranges, 16 to 22 and 57 to 60 years . Psoriasis lesions are characterized by hyper-proliferation with incomplete differentiation of epidermal keratinocytes and decreased keratinocyte apoptosis, associated with inflammatory cellular infiltrate in both dermis and epidermis . Psoriasis Area and Severity Index score is currently the preferred method for the assessment of the disease severity and extent .
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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.
Vitamin D3 Derivates: Calcipotriol Tacalcitol Calcitriol
Vitamin D analogs regulate epidermal cell proliferation and differentiation, as well as production and release of proinflammatory cytokines. Topical formulations containing vitamin D3 and vitamin D analogs are effective treatments for PP, both as monotherapies and in fixed combinations with corticosteroids. Vitamin D3 derivates appear to be more effective in treating nail bed signs of psoriasis than in nail matrix signs. Studies using calcitriol in the treatment of nail psoriasis are rare. One case was reported whereby the patient responded well to treatment with calcitriol ointment however, it was not completely clear whether this patient suffered from nail psoriasis. One RCT compared calcitriol ointment twice daily with betamethasone diproprionate on subungual hyperkeratosis . After 20 weeks, nails treated with calcitriol had a 38 % reduction in thickness compared with a 35 % reduction seen in nails treated with betamethasone diproprionate .
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Other Nutrients For Psoriasis
Vitamins are not the only types of nutrient that might help reduce psoriasis symptoms.
Omega-3 fatty acids, commonly found in fish and flax seeds, glucosamine and chondroitin, and methylsulfonylmethane may help to reduce inflammation and assist skin health.
While people often recommend the above vitamins to treat psoriasis, the most reliable solution is to eat a nutritious, balanced diet, free from processed food, alongside conventional treatments.
The United States Food and Drug Administration does not regulate dietary supplements. It can be difficult to make sure that all ingredients in a supplement are both of a high quality and mentioned on the packaging.
Ask a doctor to recommend reliable brands that include the ingredients on the label.
Supplements that contain unnamed ingredients may interfere with other medications a person is taking.
The cornerstone of psoriasis treatment is prevention. Avoiding certain triggers can prevent psoriasis from flaring up. This can help to reduce reliance on over-the-counter and pharmaceutical medications.
Some prevention tips to keep in mind include:
- minimizing stress levels
- keeping the skin moisturized, as outbreaks are more likely to occur on dry skin
- staying inside as much as possible during the winter, as cold weather can dry the skin
- using a humidifier during the colder months to help keep the skin moist and prevent outbreaks
Preventive Measures To Reduce The Frequency Of Psoriasis Attacks
There is no known way to prevent psoriasis. However, it is possible to reduce the frequency and intensity of attacks. In addition to careful monitoring of the prescribed treatment, it is possible to observe what triggers the onset of symptoms.
This process takes time and patience. Here are some general tips:
- During long exposure to the sun, it is advisable to use an effective sunscreen.
- Alcohol consumption must be greatly diminished or eliminated altogether.
- The severity of psoriasis is often related to the number of cigarettes smoked. Try to reduce tobacco or stop smoking.
- Some sufferers have their disease diminish considerably after losing a little weight. Consider changing lifestyle habits accordingly if necessary.
- It is recognized that stress plays a role in the onset or exacerbation of psoriasis attacks. Find solutions for a better stress management.
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How To Test Psoriasis And Vitamin D Deficiency
Vitamin D levels can only be accurately measured by drawing your blood by you or a healthcare practitioner in a medical testing facility. The blood test that you need is called a 25-hydroxy vitamin D test.Ways to get your Vitamin D levels checked
Results in some organizations are posted on their websites and can be checked using your unique identification pin code included in every test package.
What Are The Effective Forms Of Vitamin D
Vitamin D can be classified into two forms, D2 and D3.
Vitamin D3 is the recommended and natural source of Vitamin D that your body produces out of the sunlight, and can also be obtained from animal tissue .
While Vitamin D2 plant-based Vitamin D are derived from mushrooms cured with ultraviolet light. However, nutritionists recommend using D3 because of its potency.
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Try A Vitamin D Ointment
Vitamin D topical ointments are often used to counteract the abnormally fast regeneration of skin cells that can lead to psoriasis plaques. Prescription ointments or creams that contains active or synthetic vitamin D3 include Dovonex and Vectical , says the NPF.
If you put something on the skin that slows growth, it may cause the plaques to become thinner and less scaly, says Richard Gallo, MD, PhD, the founding chairman of the dermatology department at the University of California in San Diego.
Apply a thin layer to psoriasis plaques once or twice a day, or as recommended by your doctor. These medications can be used alone or with topical corticosteroids. Most people notice an improvement after using them for two weeks, according to the American Academy of Dematology.
Where You Can Order A Vitamin D Level Test Online
The United States of America
Heartland Assays is a small mid-west company located in Ames, Iowa and is excited to be partnering with the Vitamin D Council in providing affordable vitamin D blood spot testing to its readers, subscribers and the general public.
The Great Plains Laboratory, Inc. is the global leader in metabolic, environmental, and genetic testing for people with chronic illnesses and diseases. They offer a variety of clinical tests which help diagnose underlying conditions that are not routinely available through other laboratories.
ZRT is a CLIA certified diagnostic laboratory and the leader in hormone and wellness testing. They provide accurate and meaningful test results that assist healthcare providers in making informed treatment decisions. ZRT has developed and refined Vitamin D testing in dried blood spots.
The United Kingdom
Cityassays.org.uk offer a home test kit for Vitamin D using dried blood spot technology. This work is performed in the NHS Vitamin D laboratory that also offers a national Vitamin D service for the NHS in the United Kingdom.
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Topical Vitamin D In Psoriasis Treatment
The therapeutic effects of topical vitamin D occur via a VDR mediated genomic mechanism resulting in inhibition of keratinocyte proliferation and mediated non-genomic mechanisms inducing keratinocyte differentiation by increasing intracellular calcium levels . The anti-inflammatory effects may also result from inhibition of production of IL-2, IL-6, and interferon-gamma . Further, topical calcipotriol inhibits human beta defensin and proinflammatory cytokines which are found in increased levels in psoriatic lesions . Allelic variations in individual VDR genes may determine a different response to treatment: the isoform A of VDR is associated with a greater therapeutic response in psoriatic patients .