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Psoriatic arthritis (PsA) doesn’t just affect your joints — it can show up in your nails, too. Nail problems are common but easy to miss, and up to 90 percent of people with PsA have nail psoriasis or other nail changes. These changes may affect one nail or many, on the fingers or toes, and may include lesions, fungal infections, or other problems.
Psoriasis and PsA, collectively called psoriatic disease, cause a person’s immune system to mistakenly attack its own healthy cells. According to the National Psoriasis Foundation, approximately one-third of people with psoriasis develop PsA.
Nail psoriasis may be among the first symptoms of PsA. There’s also a connection between the severity of nail disease and the severity of joint and skin disease in people with PsA. Below are some of the nail changes associated with psoriasis and PsA.
Grooves and ridges may appear on the nails when you have PsA. Psoriatic arthritis nail ridges can be horizontal (also called Beau’s lines) or vertical. “Does anyone else have ridges in their nails?” one MyPsoriasisTeam member asked.
Another replied, “I have ridges and pits in my fingernails.”
Some people with PsA find that their nails turn color. Different hues may appear, but yellow-red is common and can look like a fungal infection.
Shallow or deep depressions in the nails may appear, known as pitting. “I’ve noticed my fingernails have started pitting. Could this be linked to my condition?” one member asked.
Another replied, “I also have nail pitting on my fingernails off and on.”
Separation of the nail plate from the nail bed is called onycholysis. Because of the gap between the skin and the nail, more bacteria can enter the area, raising the risk of developing an infection.
Fungal infection, called onychomycosis, may develop in people with PsA. A dermatologist can check your nails and prescribe treatment to clear the infection.
Reddish-brown streaks of blood in the direction of nail growth are called splinter hemorrhages. “I have splinter hemorrhages, ridges, and nail lifting on my toenails,” one MyPsoriasisTeam member wrote. “I am seeing my rheumatologist tomorrow to see if there’s anything they can do.”
PsA can cause nails to become thick and hard to manage. This thickness may make it challenging to clip your nails. “I can’t even get the toenail clippers around my fingernails,” one member wrote.
There are more treatment options than ever for both PsA and nail psoriasis. But be patient — nails grow slowly, so it may take six months or longer to see improvements.
Treatments applied directly to the nails can be helpful in the earlier stages of nail PsA. Topical treatments for psoriasis skin symptoms, such as corticosteroids and calcipotriol (a form of vitamin D), can help reduce symptoms such as buildup under the nails.
Other topical treatments may also be effective for treating nail pitting, discoloration, and separation.
About one-third of people with nail symptoms also have a fungal infection. Antifungal medications can treat the infection but not the underlying problem of nail psoriasis, so the nail may get infected again.
Corticosteroid injections into the nail matrix can help treat nail psoriasis. The nail matrix is the tissue under the skin at the base of the nail where new nail cells grow. The medication is delivered near or directly into affected nails to treat buildup, ridges, thickening, and separation. If the first corticosteroid treatment doesn’t work well, your doctor may suggest getting another in a few months.
Sometimes, phototherapy can be effective in improving psoriatic nail problems. Psoralen plus ultraviolet A (PUVA) is a type of phototherapy in which a person either takes a drug called psoralen orally (by mouth) or soaks their affected nails in it. Then, UVA rays are directed carefully at the nails.
Systemic treatments work throughout the body and may be used for severe psoriatic nail problems. Nail changes can also improve with PsA treatments such as antirheumatic drugs like methotrexate, biologics, or JAK inhibitors. As with other treatments for nail problems, it may take several months before you see results.
In the case of psoriatic nail problems, protection and prevention are key. You’re more likely to see faster improvement when your PsA treatment is combined with a nail care plan to make sure your nails stay healthy.
To protect your nails, try these tips from the American Academy of Dermatology:
Nail problems are common in PsA, but there are ways to manage them. Ask your doctor about treatment options and nail care steps that can help protect your nails, reduce infections, and improve how they look and feel. Working with your care team can make nail changes easier to manage as part of your overall PsA treatment plan.
On MyPsoriasisTeam, people share their experiences with psoriasis and psoriatic arthritis, get advice, and find support from others who understand.
Has psoriatic arthritis affected your nails? Let others know in the comments below.
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I have just read this and I have almost lost all of my finger nails I still have a few which are like splinters and I have been told that they won't grow back. I also have trouble with my 2 big toe… read more
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