Nail Psoriasis: Psoriasis in Fingernails and Toenails

By Skin & Hair Academy | November 02, 2022
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According to statistics, approximately 20% of the world’s population is affected by some type of skin condition. The most common is psoriasis: a chronic inflammatory skin condition that manifests in red or silvery patches covered by silvery scales.

While nail psoriasis is a condition many people are unaware of, it can greatly affect the self-confidence of those afflicted. When someone has a chronic condition, it can have a huge negative effect on the person both psychologically and physically. Over 70% of people with psoriasis find the condition distressing, especially when it appears on parts of their body that can be easily seen (such as hands and feet). One popular method of hiding nail psoriasis discolouration is covering it up with nail colour, but hiding does not equal treatment of underlying psoriasis.

This blog covers all aspects of nail psoriasis to help you understand what the condition is and the available routes of treatment for it.

What is nail psoriasis?

Nail psoriasis is a form of psoriasis that affects the fingernails and toenails. The nails may become thick and brittle, and they can develop pits, ridges, and discolouration.

There are two types of nail psoriasis:

  1. Guttate nail psoriasis
  2. This type of nail psoriasis causes small, rounded spots on the nails and has no symptoms other than nail changes.

  3. Chronic paronychial nail psoriasis
  4. This type of nail psoriasis usually causes inflammation around the cuticle or under the nail bed and affects several nails at once. This type of nail psoriasis can also affect other skin areas such as the scalp, elbows, knees, groin area or genitals (in men).

Is nail psoriasis fungal?

A fungus infection does not cause nail psoriasis. The exact cause of nail psoriasis isn’t known, but it’s believed to result from an increase in cell turnover (the process by which old cells are replaced with new cells). When this process goes awry, skin cells build up under the nail plate, causing it to thicken and become discoloured. The buildup may also form scales on top of the nail plate that resemble layers of parched dirt or “psoriatic scales.”

Is nail psoriasis contagious?

Nail psoriasis can be painful, but it’s not contagious. It’s caused by the same immune system malfunction that causes plaque psoriasis — a chronic inflammatory condition that affects the skin. It can be difficult to treat due to its location on the body.

Nail psoriasis symptoms?

Symptoms of nail psoriasis include:

1. Thickened nails with yellow or white spots and ridges on the nail surface. This is the most obvious symptom of nail psoriasis.

2. Changes in colour and shape of the nail plate (the visible part of your nail). These changes can include crumbling or pitting of the nails, fissuring (splitting), subungual hyperkeratosis (thickening of the skin beneath the nail), and onycholysis (splitting off).

3. Changes in texture include pitted nails or ridges on top of the nail bed.

A few of these symptoms, especially in nail-pitting psoriasis, can make the movement of fingers and toes painful. This can make it difficult to perform day-to-day activities as normal.

Treatment and prevention

Nail psoriasis is manageable with the right treatment. Nail psoriasis is resistant to some treatment options, so your healthcare provider may experiment with a few options, including:

  1. Corticosteroids
  2. Corticosteroids are most effective in treating your nail psoriasis if they reach the area where the nail begins to grow. However, they are not an instant treatment, and visible improvement may not be visible until 6 – 8 months.

  3. Injections
  4. When nail psoriasis is more severe, your healthcare provider may inject medicine directly into the skin around your nails.

  5. Phototherapy
  6. Phototherapy, which uses ultraviolet light to treat some skin conditions like psoriasis and eczema, combines a drug called psoralen with either UV-A or B lamps.

  7. Laser Therapy
  8. Your healthcare provider may use a pulsed dye laser to target the blood vessels under your nails. This procedure reduces nail psoriasis severity by shrinking these blood vessels once every six months or so.

The symptoms of nail psoriasis can be severe or mild, so even if your symptoms are mild, you should still see a healthcare provider who can determine what treatment is right for you.

Prevention of Nail Psoriasis

Regular nail care is the best way to prevent nail psoriasis causes. These prevention tips reduce the risk of contracting nail psoriasis:

  • Trimming your nails short
  • Filing the nails for a smooth edge
  • Moisturising nails and cuticles after coming in contact with water
  • Wearing comfortable shoes which are not tight

Conclusion

The symptoms of nail psoriasis can be severe or mild, so even if your symptoms are mild, you should still see a healthcare provider who can determine what treatment is right for you. Seeking the right course of treatment will reduce the physical and psychological effects of nail psoriasis. Visit the Skin and Hair Academy platform to learn more about psoriasis and other skin diseases. You can also consult with expert dermatologists and skin experts on the platform.

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