Liam Carter
Nail psoriasis is an autoimmune condition that affects the fingernails and toenails. It is caused by an overactive immune system, which causes skin cells to reproduce every three to four days, resulting in inflammation and new skin cell growth at an accelerated rate. This can lead to changes in the appearance of the nails, such as thickening, pitting, and discoloration. While there is currently no cure for nail psoriasis, various treatments are available to manage the condition, including oral and topical medications, injections, and phototherapy. As nails grow slowly, it can take time for treatments to show results, and symptoms may return.
| Characteristics | Values |
|---|---|
| Definition | Nail psoriasis is an autoimmune condition that affects your fingernails and toenails. |
| Symptoms | Pitting, thickness, discoloration, nail ridges, nail separation, nail crumbling, nail fungus, and nail pain. |
| Treatments | Corticosteroid injections, oral medications, topical medications, biologic drugs, nail removal, and antifungal medications. |
| Prevention | Avoid triggers like sunburn, bug bites, stress, and exposure to cold air. Maintain good nail care and hygiene practices. |
| Prognosis | Nail psoriasis is a chronic condition with no cure, but various treatments can help manage symptoms and prevent worsening. |
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What You'll Learn
Nail psoriasis symptoms
Nail psoriasis is an autoimmune condition that affects the fingernails and toenails. It causes nail changes, including discoloration, pitting, and changes in nail structure. While nail psoriasis cannot be cured, there are various treatments available to alleviate symptoms.
Discoloration
The skin underneath the nails (nail bed) may change colour. These changes, called salmon patches or oil drop spots, may appear yellow, red, pink, brown, grey, or purple, depending on the contrast with the skin tone.
Pitting
Nails may develop pits or dents, ranging from 0.4 to 2 millimetres in size. These can be shallow or deep, and may appear on one or more nails.
Changes in Nail Structure
Grooves or ridges may develop horizontally across the nails (Beau's lines). Nails may also become thin and brittle, crumbling or peeling away from the nail bed (onycholysis). This can lead to the development of nail fungus. Nails may thicken and separate from the nail bed, causing pain and tenderness.
Debris Buildup
Chalky white material can gather under the nail, causing it to lift away from the skin. This debris buildup can be painful and may take six months or longer to clear.
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Treatment options
Prescription Medications
Medications that can be prescribed by a dermatologist or podiatrist include:
- Corticosteroids: These can be applied topically as creams or injected directly under the nail surface every two to nine months. Corticosteroids can be used to treat most signs and symptoms of nail psoriasis, including thickness, pitting, and discoloration.
- Vitamin D Derivatives: Medications like calcipotriol, derived from vitamin D, are useful for treating the buildup that can develop beneath the nails.
- Retinoid Creams: Tazarotene, derived from vitamin A, can treat pitting, nail separation, and discoloration. However, it may irritate the surrounding skin.
- Biologic Drugs: Artificially manufactured medications like etanercept (Enbrel), adalimumab (Humira), ustekinumab (Stelara), and secukinumab (Cosentyx) target specific parts of the immune system that trigger inflammation.
- Methotrexate: This medication can be prescribed to treat nail psoriasis.
- Antifungal Medicines: Oral and topical antifungal treatments are used to treat nail fungus, which often accompanies psoriasis.
Over-the-Counter Drugs
Over-the-counter drugs that can be used to manage symptoms include:
- Hydrocortisone Cream: This can be applied topically to help reduce inflammation and treat symptoms.
- Aloe Vera Gel: With its anti-inflammatory properties, aloe vera gel can be applied to the nails and surrounding skin to relieve symptoms.
- Capsaicin Creams or Ointments: Capsaicin, a compound found in hot peppers, may help relieve symptoms when applied topically.
Cosmetic Repairs
Cosmetic repairs can be used to improve the appearance of nails affected by psoriasis:
- Nail Polish: Applying nail polish can help hide pits, discoloration, and other changes in the nail's appearance.
- Buffing: Gently buffing the nails can reduce the visibility of symptoms.
It is important to note that treatment for nail psoriasis can be challenging and may require trying different approaches. Additionally, maintaining proper nail care, such as keeping nails trimmed short, wearing gloves during certain activities, and avoiding fake nails, can help manage the condition.
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Triggers and prevention
While there is currently no cure for nail psoriasis, there are treatments that can help alleviate symptoms. It is also not possible to prevent nail psoriasis, but early treatment can help prevent it from worsening.
Triggers
Nail psoriasis is an autoimmune condition that affects the fingernails and toenails. It causes discoloration, pitting, and changes in nail structure. It is characterised by new skin cells growing too quickly, every three to four days, instead of every 28 to 30 days. This rapid growth of skin cells creates a skin rash and can also affect the nails, causing them to thicken, develop pinprick holes, change colour or shape, and become tender and painful.
Anyone can get nail psoriasis, but certain factors increase the likelihood of developing it. These include being over 40 years old, having psoriasis or a family history of psoriasis, and having psoriatic arthritis.
Prevention
While nail psoriasis cannot be prevented, there are ways to manage the condition and reduce its impact on your life. Good nail care is the best way to treat nail psoriasis. This includes keeping your nails trimmed short, using a nail file to smooth nail edges, moisturising your nails and cuticles daily and after contact with water, and wearing comfortable shoes with enough room for your toes.
In addition to nail care, there are medical treatments available for nail psoriasis. These include prescription and over-the-counter medications, such as corticosteroids, vitamin D derivatives, and retinoid creams. In more severe cases, medicine injections or oral medications may be prescribed. It is important to follow the treatment plan provided by your healthcare provider and to keep all dermatology appointments to monitor the condition and adjust treatment as needed.
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Diagnosis and grading
Nail psoriasis is an autoimmune condition that affects the fingernails and toenails. It is characterised by changes in nail appearance, such as thickening, pitting (small pinprick holes), and colour or shape changes. Discolouration can manifest as yellow, red, pink, white, or brown spots, known as salmon patches or oil drop spots. Ridges, grooves, and debris buildup may also be present.
The condition is typically diagnosed through a physical examination by a healthcare provider. They will examine the affected nails for common signs and symptoms of nail psoriasis. Additionally, the provider will inquire about the patient's symptoms, including any pain or tenderness associated with the condition, and their family history. This comprehensive approach aids in making an accurate diagnosis.
Once nail psoriasis is diagnosed, grading its severity is important for guiding treatment decisions. The Nail Psoriasis Severity Index (NAPSI) is a tool used to assess the severity of nail psoriasis. This index involves dividing the nail into four equal sections, or quadrants, using imaginary lines. By analysing the extent and characteristics of the condition within each quadrant, healthcare providers can grade the severity of nail psoriasis.
It is important to note that nail psoriasis can significantly impact an individual's quality of life, and early diagnosis and appropriate grading are crucial for effective management. Treatment options are available, including prescription medications, to help manage symptoms and improve nail appearance.
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Nail care
Nail psoriasis is an autoimmune disease that affects your fingernails and toenails. It causes nail discolouration, pitting, and changes in nail structure. While nail psoriasis isn't contagious, it can be challenging to treat. Nails grow slowly, so it can take six months or longer to clear debris beneath the nail, a common sign of nail psoriasis.
- Moisturise your hands—Psoriasis dries out your skin and nails. Applying a thick cream or ointment moisturiser after each hand wash and within three minutes of bathing can help lock in moisture.
- Leave your cuticles alone—Cutting or pushing your cuticles can injure your skin or lead to an infection. When people with psoriasis injure their skin or get an infection, it can trigger a flare-up.
- Keep your nails clean and dry—This will help prevent nail infections.
- Avoid biting or picking at your nails—This can injure your skin and increase your risk of infection.
- Take medication and apply treatments as instructed—Follow your dermatologist's directions for applying medication, as some treatments may irritate the surrounding skin.
- Regularly clean, trim, and moisturise your nails, and protect them from harm—You can buff your nails and apply nail polish to improve their appearance.
- Consider home remedies—After checking with your healthcare provider, you may want to try aloe vera gel, capsaicin creams, or Dead Sea salt soaks to relieve symptoms.
It is important to note that combining a treatment plan with recommended nail care will likely lead to better results. Additionally, it may take time to find the right treatment, and you may need to try a few before finding one that works for you.
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Frequently asked questions
Nail psoriasis is an autoimmune condition that affects your fingernails and toenails. It causes nail changes such as discoloration, pitting, and changes in nail structure.
There are several treatment options available for nail psoriasis, including prescription and over-the-counter medications, phototherapy, and biologic drugs. Your healthcare provider may prescribe corticosteroid creams, ointments, nail polish, or injections. Oral medications and topical antifungal treatments may also be recommended.
Nails grow slowly, so it can take time for treatments to show improvement. It may take six months or longer to clear debris beneath the nail, a common sign of nail psoriasis. Toenails can take 12 to 18 months to fully grow out.
