The inflammatory response of psoriatic arthritis (PsA) is systemic, and its symptoms frequently manifest in the skin, joints, and nails. Almost 90 percent of people with PsA develop nail lesions or psoriasis of the nail. Nail psoriasis, fungus, infections, and other problems can affect the nails on the fingers and toes, and one nail or all 20 nails can be affected.
Psoriasis and psoriatic arthritis (PsA), collectively called psoriatic disease, are autoimmune diseases. Autoimmune disorders cause a person’s immune system to overactivate and mistakenly attack its own healthy cells. Approximately 30 percent of people with psoriasis develop PsA. These individuals may experience higher rates of nail disease than people with psoriasis alone. Nail psoriasis usually occurs several years after skin psoriasis appears, and may be among the first symptoms of psoriatic arthritis.
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There is a strong correlation between the severity of nail disease and the severity of both joint and skin disease. Usually, the more severe the symptoms (inflammation, swelling, pain) of the joint where the nail develops (called the distal interphalangeal joint), the more severe the nail involvement will be.
Nail symptoms are often treatable. The treatment options available for both PsA and nail psoriasis are more plentiful and better today than ever before. Be patient — nails grow slowly, so it may take six months or longer to see improvements.
Topical nail therapies can be helpful in the earlier phases of nail changes. Topical treatments used for psoriasis’ skin symptoms, such as potent corticosteroids and calcipotriol (a vitamin D analog), can help reduce buildup under the nails and other symptoms. In one study, researchers found calcipotriol to be equally effective as potent corticosteroids at treating nail buildup.
Topical polyurethane nail treatments help the nail appear more normal, but do not address the inflammation directly.
About one-third of people with nail symptoms also have a fungal infection. Fungal infections of the nail can be treated with antifungal medications. However, the underlying problem of nail psoriasis remains, and the nail is likely to be infected again in the future.
Corticosteroid injections into the nail matrix behind the cuticle can be effective for the treatment of nail psoriasis. Injections of corticosteroids are delivered near or directly into the affected nails to treat nail buildup, nail ridges, nail thickening, and toenails or fingernails separating from their digits. If the first treatment shows poor results, your doctor may suggest getting another one in a few months.
Sometimes, laser treatment can be effective in addressing psoriatic nail involvement. PUVA is a type of phototherapy in which the person ingests or soaks their affected nails in a drug called psoralen. Then UVA rays are directed carefully at the nails. Although PUVA isn’t very effective in treating pitted nails, it can help to address nail discoloration and nails separating from fingers or toes.
Systemic treatments (those that work throughout the body) are a treatment option for severe psoriatic nail problems. Systemic treatments, such as biologics or antirheumatic drugs, are sometimes used to treat systemic inflammation of PsA including nail manifestations.
As with other treatments for nails, it can take months to see results.
Systemic medications for psoriasis that can help clear both the skin and nails include:
Oral nail supplements containing biotin may help the nails grow stronger.
As they say, prevention is better than cure. 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:
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 89,000 members with psoriatic arthritis 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 health care team addressing the symptoms? Let us know in the comments below, or start a conversation of your own on MyPsoriasisTeam.