Psoriasis affects more than skin — it can also develop on fingernails and toenails, leading to symptoms that may look like a nail fungus or infection. In fact, about half of the people with psoriasis say it affects their nails. Studies show that up to 90 percent will have nail symptoms eventually. Nail psoriasis also affects about 80 percent of people who have psoriatic arthritis.

Dr. Raja Sivamani, a dermatologist and an adjunct associate professor of dermatology at the University of California, Davis, spoke with MyPsoriasisTeam about the challenges of nail psoriasis. “We depend on our nails, and we sometimes take it for granted how often we use our nails for things,” Dr. Sivamani said.

Here’s how proper treatment can keep nail psoriasis from negatively affecting your quality of life.

What Does Nail Psoriasis Look Like?

Symptoms of nail psoriasis can be mild or severe. Pitting (dents) is the most common sign, but other symptoms may include:

• Discoloration
• Splitting
• Peeling
• Subungual hyperkeratosis (buildup of a chalky substance beneath the nails)
• Blood under the fingernails or toenails
• Onycholysis (separation from the nail bed)
• Cracking
• Deformed shape
• Onychomycosis (fungal infection)

People with psoriatic arthritis may also experience stiff fingers and hands because of joint inflammation. In the most severe cases, fingernails or toenails can become painful or fall off and make it harder to wear shoes, walk, or do tasks with your hands.

For many people with mild nail psoriasis, the symptoms aren’t painful, but their appearance may make a person feel uncomfortable. However, having nail psoriasis raises the risk of fungal and other nail infections. Your dermatologist should take a nail scraping or clipping to test for infections.

Causes of Nail Psoriasis

Researchers believe that, like psoriasis and psoriatic arthritis, nail psoriasis is partly caused by inflammation from an overactive immune response. Normally, infections, stress, or trauma trigger the immune system to send white blood cells to the affected area. The blood cells attack and destroy harmful substances, leading to inflammation — an essential part of the healing process.

However, in autoimmune conditions like psoriasis, the immune system stays active for too long. Even when there’s no infection, white blood cells are still deployed and attack healthy tissue.

Some people with psoriasis develop nail psoriasis as an early signal of psoriatic arthritis. If you notice nail changes plus stiffness in your hands or other joints, talk to your doctor right away.

Nail Psoriasis Treatment Options

There are lots of options to help treat nail psoriasis. Some can be done at home, while others require a prescription. Keep in mind that it takes time for nails to grow out healthy again once treatment begins. It’s best to address the issue sooner rather than later.

Examples of strategies include:

• Topical treatments — Steroids, vitamin D-based creams, or other medicated ointments can be applied to nails and cuticles to slow skin cell growth.
• Systemic medications — Biologics, immunosuppressants, and disease-modifying antirheumatic drugs (DMARDs), like methotrexate, can help reduce inflammation.
• In-office treatments — Laser treatments, steroid injections, and phototherapy can be done by your doctor to target affected nails.

Nail treatments often “require an internal approach,” according to Dr. Sivamani. “If you’re in an inflamed state, we need to get you down,” he said, referencing systemic medications that lower inflammation.

“[Another] key with nails is that you have to be patient to let that more normal-looking nail grow out — it takes time,” Dr. Sivamani said. It usually takes four to six months for fingernails to completely grow out, and a toenail may take a year.

Home Remedies To Treat Nail Psoriasis

Some MyPsoriasisTeam members manage nail psoriasis using home remedies, including moisturizers to help their nails and skin look and feel healthier. One member swears by raw, unscented shea butter: “I use it on my cuticles and on psoriasis spots on my body. It helps a lot!”

Another said their skin and nails don’t respond well to any single treatment: “I use a variety of lotions and potions on my hands to ease it.”

A third member recommended Aspercreme with aloe to both relieve pain and moisturize.

Lifestyle Changes To Manage Nail Psoriasis

People with nail psoriasis can follow some simple habits to help keep their fingernails and toenails healthier and the condition in check. For example:

• Wear gloves when using cleaning products, including washing dishes. Water and harsh chemicals damage even healthy nails.
• Keep your nails short. The less your nails catch and tear on other objects, the healthier they’ll be.
• Moisturize regularly. Keeping skin and nails as supple as possible will help them stay healthier.
• Leave your nails alone. Don’t bite or pick at your nails or cuticles. If you have problems with hangnails, find a good manicurist who understands your concerns, or ask your dermatologist for help.
• Be careful with artificial and gel nails, which can damage already weak nail beds. Strengthening nail polish or nail polish strips — which some MyPsoriasisTeam members suggest — may be better alternatives, but check with your doctor before investing any time or money in these products.

Social and Emotional Effects of Nail Psoriasis

Symptoms of nail psoriasis can cause embarrassment and social discomfort. “My fingernails and toenails look like a hot mess,” one member of MyPsoriasisTeam said.

Another member’s son was told by their employer that their nails reflected “poor hygiene.”

Being part of a supportive community can help you navigate nail psoriasis and other aspects of living with psoriasis. “I’m trying not to let it get the best of me — learning a lot from the group and glad I joined,” a member of MyPsoriasisTeam shared.

It’s also important to communicate your concerns to your dermatologist so they can make sure you’re getting the treatment you need. “I think it’s really important to let your doctor know how much it’s affecting you,” Dr. Sivamani said, adding that nails are considered a “special site that can really … affect your quality of life.”

Join the Conversation

On MyPsoriasisTeam, people share their experiences with psoriatic disease, get advice, and find support from others who understand.

Have you noticed psoriasis symptoms on your nails? Let others know in the comments below.