• Psoriatic arthritis (PsA) can cause nail problems such as discoloration, pitting, and ridges.
• Treatment options for nail symptoms include topical medications, corticosteroid injections, phototherapy, and systemic treatments.
• Nail problems may be prevented with simple strategies like keeping nails short, dry, and clean.

Psoriasis and psoriatic arthritis — collectively called psoriatic disease — cause a person’s immune system to mistakenly attack its own healthy cells. According to the National Psoriasis Foundation, approximately 33 percent of people with psoriasis develop PsA. These individuals may experience higher rates of nail disease than people with psoriasis alone. Nail psoriasis may be among the first symptoms of PsA.

Symptoms of Nail Involvement With PsA

Many nail changes are associated with psoriasis and PsA. These nail changes can include:

• Ridging — Grooves and ridges, which can be vertical or horizontal. Horizontal ridges are also called Beau’s lines.
• Discoloration — Often yellow-brown, which can look like a fungal infection
• Pitting — Shallow or deep depressions in the nails
• Onycholysis — Separation of the nail plate from the nail bed
• Onychomycosis — Fungal infection of the nails
• Splinter hemorrhages — Reddish-brown streaks of blood in the direction of nail growth
• Thickening — A feeling that the nails seem heavy

There is a strong connection between the severity of nail disease and the severity of both joint and skin disease in people with PsA. Usually, the more severe the symptoms of the joint where the nail develops (called the distal interphalangeal joint), the more the nails will be affected.

Treating Psoriatic Nail Involvement

Nail symptoms are often treatable. There are more treatment options than ever for both psoriatic arthritis and nail psoriasis. Be patient — nails grow slowly, so it may take six months or longer to see improvements.

Topical Nail Therapies

Treatments applied directly to the nails can be helpful in the earlier stages of nail changes. 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.

Tazarotene (Tazorac), a topical cream or gel, may be effective for treating nail pitting, discoloration, and separation.

Topical polyurethane treatments help the nail appear more normal but don’t directly address inflammation.

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 is likely to get infected again.

Corticosteroid Injections

Corticosteroid injections into part of the nail called the nail matrix can effectively treat for nail psoriasis. The medication is delivered near or directly into the affected nails to treat buildup, ridges, thickening, and separation. If the first corticosteroid treatment shows poor results, your doctor may suggest getting another one in a few months.

Phototherapy

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. Although PUVA isn’t very effective in treating pitted nails, it can help address discoloration and separation from fingers or toes.

Systemic Treatments

Systemic treatments (those that work throughout the body) are an option for severe psoriatic nail problems. Nail changes can also be addressed using PsA treatments, such as biologics or antirheumatic drugs. These medications include methotrexate and biologic drugs such as adalimumab (Humira), etanercept (Enbrel), and risankizumab-rzaa (Skyrizi), which are also used to treat skin psoriasis.

As with other treatments for nail problems, it can take months to see results.

Five Ways To Prevent Nail Problems and Preserve Nail Health

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 coupled 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 Association:

• Keep your nails short to help prevent them from lifting off your fingers and toes and to prevent buildup under the nails.
• Keep your nails dry and clean to help prevent nail infections.
• Wear gloves while washing dishes or gardening to avoid irritating your skin or nails, which may cause flares.
• Don’t cut or push back your cuticles. Injured cuticles can lead to infection or a psoriasis flare.
• Pass on artificial nails at your next manicure. Artificial nails can increase the risk of your nails separating from your fingers. Instead, opt for nail polish and gentle buffing.

Find Your Support

Psoriatic arthritis can be tough, but you don’t have to face it alone. MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. Here, more than 113,000 members with PsA understand what you’re going through and share daily ups and downs in a supportive environment.

Has psoriatic arthritis affected your nails? How are you and your dermatologist or rheumatologist addressing the symptoms? Let us know in the comments below, or start a conversation of your own on your Activities page.