Liam Carter
Psoriasis is an inflammatory autoimmune disease that affects the skin, joints, and nails. It can cause the nail plate to lose cells, resulting in small pits forming on the nails, which may resemble dents caused by the tip of a pen. This condition, known as nail psoriasis, can affect both the fingernails and toenails, with a higher prevalence in fingernails. The number and depth of pits vary, and nails may also become thicker due to a fungal infection called onychomycosis, which is common in people with psoriasis. Additionally, the nails may exhibit discoloration, appearing yellow-brown or white, and in severe cases, the lunula may turn red due to dilated blood vessels. Treatment options include corticosteroid injections, oral medications, and vitamin D analogue creams or ointments.
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What You'll Learn
Psoriasis is an inflammatory autoimmune disease
Nail psoriasis is a type of psoriasis that affects the nails on both the fingers and toes, causing changes in the appearance and texture of the nails. It is characterised by nail pitting, which presents as small dents or pits on the nail surface that can range from pin-sized to crayon-tip-sized. These pits can be shallow or deep, and there may be just one or two, or more than ten on each nail. In more severe cases, the nails may crumble due to the weakness of the supporting structures.
Another common feature of nail psoriasis is nail bed separation, also known as onycholysis. This occurs when the nail lifts up and separates from the nail bed, which is the skin underneath the nail plate. Onycholysis can lead to the development of nail fungus and may cause pain or discomfort. Nails affected by psoriasis may also become thicker due to a fungal infection called onychomycosis or the development of a chalky substance underneath the nail, known as subungual hyperkeratosis.
Nail discoloration is also a prominent symptom of nail psoriasis. Nails may exhibit yellow, red, pink, or brown patches, resembling oil drops under the nail plate, known as "oil-drop spots." More severe cases may cause the lunula, the small half-moon shape at the bottom of the nail, to turn red due to dilated blood vessels. Additionally, reddish-purple lines called splinter hemorrhages may appear on the nails, along with blood spots of the same name. In some cases, nails may turn yellow-brown, while crumbling nails often turn white.
The treatment for nail psoriasis aims to prevent the condition from worsening and typically involves prolonged management. Topical treatments, such as corticosteroid creams, ointments, or nail polish, are applied directly to the nails and must reach the nail bed and nail matrix to be effective. Vitamin D analogue creams or ointments massaged into the cuticle have also been found to be effective. In more severe cases, oral medications, injections of corticosteroids or other psoriasis medications, and systemic treatments may be prescribed to address both nail and skin psoriasis.
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Nail changes include pitting, ridging, and crumbling
Psoriasis is a common skin condition that can cause changes in the nails, known as nail psoriasis. It is an autoimmune disease that causes skin cells to reproduce quickly, leading to new skin cells growing too fast. Nail psoriasis typically appears alongside a psoriatic rash on other parts of the body, but it can also develop without any signs of psoriasis on the skin. It is not contagious or a fungus.
Nail changes are among the symptoms of nail psoriasis. These changes include pitting, ridging, and crumbling of the nails. Pitting refers to the dents or pits that develop on the nails, ranging in size from as small as a pin tip (0.4 mm) to as large as a crayon tip (2 mm). These pits can be shallow or deep, and there may be anywhere from one or two to more than ten pits per nail.
In addition to pitting, nail psoriasis can cause ridging or grooving that runs horizontally across the nails, known as Beau's lines. The nails may also become thin and brittle, leading to crumbling. In some cases, the nails may thicken due to a fungal infection called onychomycosis, which is common in people with psoriasis. This thickening can also be caused by the development of a chalky substance underneath the nail, known as subungual hyperkeratosis, which may be painful or uncomfortable.
Nail psoriasis can be treated with various methods, including corticosteroid injections, oral medications, and topical treatments. Treatment can help prevent the condition from worsening and improve the appearance of the nails. However, it is important to note that there is currently no cure for nail psoriasis, and treatments focus on managing symptoms.
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Nails may change colour or develop blood spots
Psoriasis is a common skin condition that can cause changes in the colour of nails. If you have nail psoriasis, you may first notice a yellow discolouration at the tip of a nail. The colour change may eventually spread to the cuticle. In more severe cases, the lunula (the small, half-moon shape that appears at the bottom of your nail) may turn red due to dilated blood vessels. You might also notice very narrow, reddish-purple lines on your nails, called splinter haemorrhages. Additionally, your toenails or fingernails can turn a yellow-brown colour. Crumbling nails often turn white.
The skin underneath your nails (nail bed) may also change colour. These changes, called salmon patches or oil drop spots, may look yellow, red, pink or brown. Oil drop spots look like a drop of oil under your nail plate. Bacteria can get into the space under the nails and cause infection, which can turn the whole nail a dark colour.
Nails may also develop blood spots. Blood spots appear as a thin line of blood beneath the nail. This can be a sign of nail psoriasis. In addition, grooves in the nails and the lifting of the nail from the finger are also signs that psoriasis is affecting your nails.
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Treatment options include steroid injections and creams
Psoriasis is an autoimmune disease that causes skin cells to reproduce quickly, resulting in scaly patches of thick, flaking skin called plaques. Nail psoriasis, in particular, affects the nails on your fingers and toes, causing changes in nail structure such as pitting, crumbling, and horizontal grooves. While anyone can get nail psoriasis, you may be more prone to it if you are over 40, have a family history of psoriasis, or have psoriatic arthritis.
Treatment options for nail psoriasis include steroid injections and creams. Steroid injections, also known as corticosteroid injections, are typically used in more severe cases of nail psoriasis. The injections are administered by a healthcare provider, who uses a thin needle to inject the medication directly into or around the affected nails. The medication targets the buildup under the nails, nail ridges, thickening nails, and nail separation. Most patients require a series of injections every four to six weeks, and it may take several months to see noticeable improvements.
Steroid creams, also referred to as topical steroids or corticosteroids, are commonly used to treat psoriasis by reducing inflammation. These creams are applied directly to the affected areas of the skin and nails, typically once or twice a day for at least six months. It is important to follow the instructions provided by your healthcare provider when using steroid creams, as long-term use can lead to side effects such as skin colour changes and adrenal fatigue.
The choice between steroid injections and creams depends on the severity of the nail psoriasis and the recommendation of your healthcare provider. Topical treatments are often the first choice for mild cases of nail psoriasis, while injections may be more suitable for more severe or persistent cases. Additionally, the effectiveness of topical treatments may be limited by the ability of the medication to penetrate the nail plate and reach the nail bed.
In addition to steroid injections and creams, other treatment options for nail psoriasis include oral medications, laser treatments, and combined local therapies using corticosteroids and vitamin D3 analogues. It is important to consult with a healthcare professional to determine the most appropriate treatment plan for your specific condition.
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It can take months or years to see treatment results
Nail psoriasis is an autoimmune condition that affects the nails on your fingers and toes. It causes discoloration, pitting, and changes in your nail structure. While there is no cure, treatments can help alleviate symptoms.
The slow growth of nails means that it can take a long time to see improvements in the affected areas. It can take months or even years for psoriasis to go into remission, a period with no symptoms. However, relapses are common, and psoriasis can reappear after long periods with no symptoms.
The duration of treatment depends on the individual, and finding the right treatment can be challenging. Treatment strategies may need to be adjusted over time, and it is important to work with your doctor to find the best approach. Treatment can improve symptoms and reduce flare-ups, but it often needs to be ongoing to keep psoriasis under control.
Topical treatments, such as corticosteroids, vitamin D, or retinoid creams, can be applied directly to the nails and cuticles. Systemic medications, such as biologics, are taken orally or through injection to suppress the immune system and treat moderate to severe psoriasis. Phototherapy, or light therapy, uses ultraviolet light to slow the growth of affected skin cells.
It is important to note that psoriasis is a highly unpredictable condition, and there is no guarantee that it will not return or worsen after treatment. Managing triggers and maintaining a treatment plan are crucial to controlling the condition.
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Frequently asked questions
Nail psoriasis is an inflammatory autoimmune disease that affects the nails on your fingers and toes.
Nail psoriasis can cause a variety of nail changes, including pitting, nail bed separation (called onycholysis), nail thickening (subungual hyperkeratosis), and discoloration (oil-drop spots).
Treatment options for nail psoriasis include corticosteroid creams or injections, oral medications, and laser therapy. Keeping nails short, neat, and clean is also important for managing the condition.
The exact cause of nail psoriasis is unknown, but it is believed to be related to a combination of genetic, immunological, and environmental factors. It often occurs in people with a family history of psoriasis or psoriatic arthritis.
Nail psoriasis is a common condition, affecting over 50% of people with psoriasis and up to 80%- 86% of those with psoriatic arthritis. It can range from mild to severe symptoms and may occur with or without skin involvement.
