• Up to 80 percent of people with plaque psoriasis and psoriatic arthritis experience nail symptoms.
• Nail psoriasis can be treated with topical treatments, systemic medications, and therapies provided in a dermatologist’s office, such as steroid injections.
• It can take up to six months for nails to fully grow out after treatment.

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. According to a 2019 review of research, from 50 percent to 79 percent of people with plaque psoriasis and 80 percent of those with psoriatic arthritis have symptoms that affect their nails.

Dr. Raja Sivamani, a professor of clinical dermatology at the University of California, Davis, empathized with a MyPsoriasisTeam member, acknowledging that it can be tough to have 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.

What Are the Symptoms of Nail Psoriasis?

Symptoms of nail psoriasis, which can be mild or severe, include:

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

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

For many people with mild nail psoriasis, the symptoms aren’t painful — even though their appearance may make a person feel uncomfortable. However, having nail psoriasis increases the risk of fungal and other nail infections, so it’s important that your dermatologist scrape your nails to determine if a fungal infection is present. Taking a biopsy (removing a small piece of skin for testing) can help the doctor diagnose your condition. Additionally, because of increased susceptibility, an infection can recur after it clears.

“You know, you just don’t have that same strength that you’re supposed to have, so your nails can become more brittle,” Dr. Sivamani said.

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,” said one member of MyPsoriasisTeam.

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,” shared a member of MyPsoriasisTeam.

What Causes Nail Psoriasis?

Researchers believe that — like plaque and psoriatic arthritis — nail psoriasis 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, even after an infection clears, a dysfunctional immune system will continue to send out white blood cells, which will attack healthy tissue. 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 signal of psoriatic arthritis. If you notice changes in your nails plus stiffness in your hands or other joints, talk to your doctor right away.

How Can You Treat Nail Psoriasis?

Depending on a case’s severity, dermatology experts can treat nail psoriasis with topical products, localized injections, or systemic (whole-body) medications. People with mild nail psoriasis can also try some simple treatments at home, which can reduce the recurrence of symptoms. Those with more severe psoriasis may consult with a specialist about potential medications. No matter which treatment you choose, it will take time for the nails to grow out and show any measurable improvement.

Medications To Treat Nail Psoriasis

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

Topical Medications

For mild cases, your dermatologist or rheumatologist will probably start with a cream or ointment that’s applied to your nails and cuticles. Topical options include:

• Potent corticosteroids
• Calcipotriene (Dovonex)
• Tazarotene (Tazorac)
• Vitamin D analogs such as calcitriol (Vectical)

Those creams have been shown to slow the overproduction of skin cells, a key symptom in psoriasis.

Systemic Medications

Methotrexate (Trexall), a common treatment for psoriasis and psoriatic arthritis, is often prescribed for nail psoriasis as well. The dosage depends on your symptoms and other medications you’re taking. Your health care provider might prescribe the immunosuppressant drug cyclosporine (Neoral) or one of the biologic treatments available for psoriasis, such as risankizumab-rzaa (Skyrizi).

Some of the newer biologics seem to have better effects on nail psoriasis than some older systemic medications. If you’re seeing both a dermatologist and a rheumatologist, make sure each doctor is aware of any treatments the other prescribes.

“The key with nail treatments [is that] … it does require an internal approach in many cases,” Dr. Sivamani said. “[Another] key with nails is that you have to be patient to let that more normal-looking nail grow out. It takes time.”

He noted that for many people, it may take four to six months for nails to completely grow out.

In-Office Treatments

Your doctor may recommend more intense treatments 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 into the nail matrix (the area where nail growth begins) can also reduce inflammation. Psoralen plus ultraviolet A — soaking your nails in psoralen or taking it orally, then exposing your nails to ultraviolet light — might also help.

Home Remedies To Treat Nail Psoriasis

Some MyPsoriasisTeam members use home remedies to manage their nail psoriasis, including moisturizers to help their nails and skin look and feel healthier. One member swears 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 relieve pain and moisturize.

Lifestyle Changes To Manage Nail Psoriasis

People with nail psoriasis can follow some simple habits to help keep their nails healthier and the condition in check.

• 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 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. 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 already weak nail beds. Strengthening nail polish or — as suggested by some MyPsoriasisTeam members — nail polish strips may be better alternatives, but you should ask your doctor before investing any time or money in these products.

Although nail psoriasis can be uncomfortable and embarrassing, you have plenty of options to help clear and strengthen your nails. It may take time to find the combination of treatments and lifestyle changes that works for you, but 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 become part of a support group of more than 112,000 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 your Activities page.