About 50 percent of those with psoriasis, and 80 percent of those with psoriatic arthritis, also go on to develop psoriatic nail disease.
Psoriasis is a chronic autoimmune disorder characterized by red, scaly skin called plaques. Psoriatic arthritis affects the joints as well as the skin. Both of these skin diseases can, and frequently do, affect the nails as well. Although fingernails are most often affected, psoriatic nail disease can affect the toenails, too.
Symptoms of psoriatic nail disease
When psoriatic disease of the nails is present, you might notice changes in the appearance of your nails, including:
Pitting — Small pits, resembling tiny dings on the surface of your nail. You might have only one pit or you might notice many pits on a single nail.
Onycholysis — Also known as separation from the nail bed, this begins with a small white or yellow patch at the tip of the nail. The patch slowly gets bigger and the nail starts to lift away. As the skin underneath the nail is exposed, it can become discolored or infected.
Subungual hyperkeratosis — A white, chalk-like substance builds up under the nail. Your nail might raise up from the skin and become tender or painful.
Nail coloring — Your nails may turn yellow, brown, or yellowish-brown.
Some people also experience splinter hemorrhages, which are small burst blood vessels under the nail. This can appear as ridging and small red marks under the nail. When not treated, psoriatic nail disease can become severe, causing pain and thickening nails, and can even cause nails to splinter and crumble. Not only is this condition painful, it can cause emotional distress because of embarrassment over how your nails look.
How psoriatic nail disease is treated
Psoriatic nail disease can be difficult to treat. Treatments, thus far, have had inconsistent results and some treatments cause pain and severe side effects.
Topical steroids can be massaged into the nail plate. This treatment helps some people but the results have been inconsistent.
Steroids can be injected directly under the nail. This is not considered a first-line treatment and the injections can cause pain.
The entire nail can be removed. Although it sounds painful, this is normally painless. However, it can take one to two years for the nail to grow back and sometimes the new nail still has an abnormal appearance.
Systemic medications are sometimes used for severe cases. However, these cause side effects and some people find the side effects are too difficult to cope with and stop the treatment.
Some doctors have found that using vitamin D creams on the nails can help to improve symptoms, according to the Psoriasis and Psoriatic Arthritis Alliance (PAPAA). There have not been any long-term clinical studies on using vitamin D creams to treat psoriatic nail disease, but PAPAA indicates many anecdotal reports from around the world have showed good results from this type of treatment.
What you can do
It is not understood why some people with psoriasis and psoriatic arthritis develop psoriatic nail disease and others do not. Because of this, there isn’t any known cause or preventive measures. However, there are steps you can take to care for your nails:
- Keep your nails trimmed and short. Use an emery board to gently file them.
- Wear gloves when outdoors during cold weather, working outdoors, cleaning with chemicals, or during other times when you could damage your nails.
- Clean your nails by soaking them in soapy, warm water. Avoid using sharp objects to clean behind your nails.
- Massage moisturizers or emollients into your nail and cuticles several times a day.
If you notice any changes in your nails, talk to your dermatologist about what treatment options might be best for you.
Nail Psoriasis: The Psoriasis and Psoriatic Arthritis Alliance
Nail Psoriasis: The Journey So Far: Indian Journal of Dermatology
Treatment of Nail Psoriasis: JAMANetwork.com