Nail Psoriasis: Symptoms, Causes, and Treatments

Psoriasis affects more than just your skin. It can also develop on your fingernails and toenails, leading to symptoms that can resemble a nail fungus or other nail infection. As many as 50 percent of people with plaque psoriasis and 80 percent of those with psoriatic arthritis (PsA) have symptoms that affect their nails as well.

What Are the Symptoms of Nail Psoriasis?

Symptoms of nail psoriasis can be mild to severe and include:

• Nail discoloration
• Splitting nails
• Peeling nails
• Buildup of a chalky substance beneath the nails (subungual hyperkeratosis)
• Pitting (dents) in the nails
• Blood under the nails
• Nails separating from the nail bed (onycholysis)
• Cracking nails
• Deformed nails
• Thickening of the nails from a fungal infection (onychomycosis)

Image courtesy of DermNet

People with psoriatic arthritis may also experience stiffness in their fingers and hands as part of nail psoriasis. In the most severe cases, nails can disappear entirely, which may hinder a person’s ability to use their hands or to walk.

For many people with mild nail psoriasis, the symptoms aren’t painful — even though they may look uncomfortable. However, having nail psoriasis increases your risk for nail infections and fungal infections so it’s important that your dermatologist scrape your nails to determine if a fungal infection is present. The infection can recur after being cleared, due to the increased susceptibility.

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,” lamented one member of MyPsoriasisTeam.

An employer told another member’s son that his 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,” shared a third member of MyPsoriasisTeam.

What Causes Nail Psoriasis?

Researchers believe nail psoriasis — like plaque psoriasis and psoriatic arthritis — is caused, in part, by inflammation resulting from a faulty immune response. Normally, infections, stress, or trauma trigger the immune system to send white blood cells to the affected area. As the blood cells attack and destroy harmful substances, inflammation occurs — an essential part of the healing process. However, a dysfunctional immune system will continue sending white blood cells once an infection is cleared, and they’ll attack healthy tissue, causing the inflammation to linger. The resulting inflammation can trigger a number of autoimmune conditions, including all forms of psoriasis.

Some people with plaque psoriasis develop nail psoriasis as an early sign of PsA. If you notice changes in your nails combined with stiffness in your hands or other joints, talk to your doctor right away.

How Can You Treat Nail Psoriasis?

Depending on the severity, nail psoriasis can be treated topically, with localized injections, or with systemic medications that treat the whole body. People with nail psoriasis can also try some simple treatments at home for mild cases, which can reduce the recurrence of the symptoms. No matter the treatment you may choose, it will take time for the nails to grow out and to see any measurable improvement.

Medications To Treat Nail Psoriasis

There are three basic types of medications for nail psoriasis: topical treatments, systemic medications, and treatments provided in a dermatologist’s office.

Topical Medications

For mild cases, your dermatologist or rheumatologist will probably start with a cream or ointment that’s applied topically to your nails and cuticles. Topical options include potent corticosteroid creams, Dovonex (Calcipotriene), Tazorac (Tazarotene), and vitamin D analog creams. Those creams have been shown to slow down the overproduction of skin cells, a key symptom in psoriasis. You may need to combine more than one topical medication to see results.

Systemic Medications

Trexall (Methotrexate) is a common treatment for psoriasis and PsA, and it’s often prescribed for nail psoriasis as well. Doses will depend on other symptoms and medications you’re taking. The immunosuppressant drug Neoral (Cyclosporine) may be prescribed, as may any number of biologic treatments on the market. Some of the newer biologics seem to have better effects on nail psoriasis than some of the older systemic medications. If you’re seeing both a dermatologist and a rheumatologist, make sure they are aware of any treatments the other is prescribing.

In-Office Treatments

Your doctor may recommend more intense treatment options in the office for cases of nail psoriasis that don’t respond well to the above options or are more advanced. You might find relief from laser treatment or corticosteroid injections. Intralesional steroid injections in the nail matrix can also reduce inflammation. Psoralen Ultraviolet A (PUVA) treatment might also be helpful, which entails soaking your nails in Psoralen or taking it orally, then exposing your nails to ultraviolet light.

Home Remedies To Treat Nail Psoriasis

Some MyPsoriasisTeam members use home remedies to manage their nail psoriasis, including incorporating moisturizers that help their nails and skin look and feel healthier. One member said they swear by an unscented, raw 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,” they wrote.

A third member recommended Aspercreme with aloe to simultaneously help with pain and moisturizing.

Lifestyle Changes To Manage Nail Psoriasis

People with nail psoriasis can make other behavioral changes that will help keep their nails healthier and the condition in check.

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

Although nail psoriasis can be uncomfortable and embarrassing, there are plenty of treatments that can make your nails clear and shiny. Whatever combination of treatments and lifestyle changes works for you, nail psoriasis can be managed.

You Are Not Alone

By joining MyPsoriasisTeam, the social network for people living with psoriasis and psoriatic arthritis, you’ll join a support group of more than 87,000 people. Managing and treating the symptoms of nail psoriasis is just one topic members discuss.

How does nail psoriasis affect your life? Have you found ways to manage the symptoms? Share your tips and experiences in a comment below or on MyPsoriasisTeam. You'll be surprised how many other members have similar stories.

References

1. Psoriasis in the Nails — The Psoriasis and Psoriatic Arthritis Alliance
2. What is Nail Psoriasis, and How Can I Treat It? — American Academy of Dermatology
3. Coexistence of Fungal Infections in Psoriatic Nails and their Correlation with Severity of Nail Psoriasis — Indian Dermatology Online Journal
4. Psoriasis: More Than Skin Deep — Harvard Health Publishing
5. Nail Fungus — Mayo Clinic
6. The 7 Ways Psoriatic Arthritis Can Change Your Nails (and What You Can Do to Avoid It) — CreakyJoints
7. Small Molecules and Biologics in the Treatment of Nail Psoriasis — Skin Appendage Disorders
8. Treatment of Nail Psoriasis With a Modified Regimen of Steroid Injections — Journal of the College of Physicians and Surgeons — Pakistan
9. Vitamin D Analogues — The Psoriasis and Psoriatic Arthritis Alliance
10. 5 Tips To Improve Nail Psoriasis at Home — American Academy of Dermatology