Nail Psoriasis

Nail psoriasis is a long-term condition that affects the nails. It causes inflammation and leads to the formation of nail plaques. This condition happens in about 50% of people with psoriasis, causing dystrophic nails. It can greatly affect the quality of life for those who have it.

It’s important to understand the symptoms, causes, and treatment options for nail psoriasis. Recognizing the signs early helps in starting treatment quickly. This can help prevent more damage to the nails and improve their health.

Even though there’s no cure for nail psoriasis, there are treatments that can help manage symptoms. Working closely with a healthcare provider is key. They can help create a treatment plan that meets your specific needs and goals.

What is Nail Psoriasis?

Nail psoriasis is a long-lasting condition that affects the nails. It often comes with skin psoriasis. The immune system mistakenly attacks healthy nail cells, causing changes in the nails.

Nail psoriasis can show up in different ways, including:

About 50% of people with skin psoriasis also get nail psoriasis¹. The severity of nail psoriasis can range from mild to severe. Some people have just a few nails affected, while others have many.

Nail psoriasis is not contagious. It can’t be spread from person to person. But, it can be very uncomfortable and affect daily life. It can hurt and make simple tasks like typing or wearing shoes hard.

Common Symptoms of Nail Psoriasis

Nail psoriasis can cause many symptoms that affect how your nails look and feel. It’s important to know these signs early for the right treatment. Common symptoms include nail pitting, discoloration, onycholysis, and subungual hyperkeratosis.

Nail Pitting

Nail pitting shows as small, shallow holes in the nail. These holes can be different sizes and more common on fingernails. It happens when psoriasis affects the nail matrix, where new nail tissue is made.

Nail Discoloration

Psoriasis can make nails turn yellow, brown, or green. Sometimes, small red or brown spots appear under the nail, called oil drops or salmon patches. These color changes can mean there’s inflammation or infection in the nail bed.

Onycholysis

Onycholysis is when the nail separates from the nail bed, starting at the tip. This gap can let bacteria and fungi in, raising the risk of infection. Affected nails may look white or yellow and feel tender or painful.

Subungual Hyperkeratosis

Subungual hyperkeratosis is when chalky material builds up under the nail, making it thick and discolored. This is due to too many skin cells, a sign of psoriasis. As it gets worse, the nail can become brittle and start to crumble or detach.

Causes of Nail Psoriasis

The exact cause of nail psoriasis is not fully known. Yet, research has found several key factors. These include genetic factors and immune system dysfunction.

Genetic Factors

Studies have found that some genetic variations can raise the risk of nail psoriasis. If your family has psoriasis or other autoimmune disorders, you might be more likely to get it. Certain genes, linked to the immune system, are also involved.

Immune System Dysfunction

Nail psoriasis is an autoimmune disorder. This means the immune system attacks healthy cells by mistake. In nail psoriasis, it targets the nail matrix, causing changes in appearance and texture. This is due to a mix of genetic and environmental factors.

The table below highlights the differences between genetic factors and immune system dysfunction in nail psoriasis:

Having a genetic predisposition or an overactive immune system doesn’t mean you’ll definitely get nail psoriasis. But knowing these risk factors helps you and your healthcare provider manage your health better.

Diagnosing Nail Psoriasis

If you think you might have nail psoriasis, getting a correct diagnosis is key. A proper nail psoriasis diagnosis helps find the right treatment. It also helps manage the condition well.

The first step is a detailed physical examination of your nails. Your doctor will look closely at your nails for signs like pitting, discoloration, and onycholysis. They might also check your skin for psoriasis elsewhere on your body.

In some cases, a nail biopsy is needed to confirm the diagnosis. A small sample of your nail tissue is taken and tested in a lab. This helps rule out other conditions that might look similar, like nail fungus.

Your doctor will also ask about your health history. They might ask about your family’s health, when your symptoms started, and how long they’ve lasted. They’ll also ask about any other symptoms you’re experiencing.

Getting a correct diagnosis is the first step to managing nail psoriasis. It helps improve your nail health and appearance. If you notice any changes in your nails, see a healthcare professional for an evaluation and diagnosis.

Treatment Options for Nail Psoriasis

There are many ways to treat nail psoriasis, depending on how bad it is and what works best for you. You can try topical treatments, systemic medications, or light therapy. Talking to a dermatologist can help find the right treatment for you.

Topical Treatments

For mild to moderate nail psoriasis, topical treatments are often the first choice. Corticosteroid creams or ointments can help reduce inflammation and slow down skin cell growth. Vitamin D analogs, like calcipotriene, also help by normalizing skin cell turnover.

These treatments are applied directly to the affected nails and skin around them.

Systemic Medications

When nail psoriasis is more severe or topical treatments don’t work, systemic medications might be needed. These drugs affect the whole body to fight the immune system issues. Methotrexate, an immunosuppressant, can slow down skin cell growth and reduce inflammation.

Biologic drugs, such as adalimumab or ustekinumab, target specific proteins involved in psoriasis inflammation.

Light Therapy

Light therapy, or phototherapy, uses UV light to treat nail psoriasis. Narrowband UVB phototherapy is a common type used. It can slow down skin cell growth and reduce inflammation.

Light therapy is done in a dermatologist’s office or with special home devices under their supervision.

Treating nail psoriasis can be tough, and results may vary. It’s important to be consistent and patient, as it may take months to see improvements. Regular check-ups with a dermatologist are key to track progress and adjust treatments as needed.

Lifestyle Changes to Manage Nail Psoriasis

Medical treatments are key for nail psoriasis, but lifestyle changes help too. Focus on keeping nails clean and avoiding damage.

Maintaining Proper Nail Hygiene

It’s important to keep your nails clean and neat. Here’s how:

• Keep nails trimmed short to reduce buildup and debris
• Use a soft nail brush to clean under and around the nails
• Avoid harsh nail cleaning or pushing back cuticles, as it can irritate the skin
• Moisturize the nails and skin around them to prevent dryness and cracking

Good nail hygiene habits can help reduce psoriasis symptoms and keep your nails looking good.

Avoiding Nail Trauma

Nail trauma can make psoriasis symptoms worse. To protect your nails:

• Wear gloves for manual labor or chores to avoid nail injury
• Avoid biting or picking at your nails or skin
• Choose well-fitting shoes to prevent nail pressure
• Be careful when trimming or filing your nails to avoid damage

By avoiding nail trauma, you can prevent psoriasis symptoms and keep your nails healthy. Lifestyle changes and medical care together can make a big difference.

The Impact of Nail Psoriasis on Quality of Life

Nail psoriasis can really change a person’s quality of life. It’s not just about the physical symptoms. The way it looks can make people feel bad about themselves and how they look.

People with nail psoriasis might feel embarrassed or self-conscious. This can make it hard for them to interact with others and feel good about themselves.

A study in the Journal of the European Academy of Dermatology and Venereology¹ shows how big of an impact it can have:

It’s important to talk about the emotional side of nail psoriasis. Doctors and healthcare workers should think about how it affects patients’ feelings. They can help by talking openly and providing support.

Also, joining support groups can help people feel less alone. Sharing stories and tips can make them feel better and more connected.

¹Klaassen, K. M., van de Kerkhof, P. C., & Pasch, M. C. (2013). Nail psoriasis, the unknown burden of disease. Journal of the European Academy of Dermatology and Venereology, 28(12), 1690-1695. https://doi.org/10.1111/jdv.12368

Nail Psoriasis vs. Nail Fungus: Understanding the Difference

Nail psoriasis and nail fungus share some symptoms, but they are different. Knowing the difference is key to getting the right treatment.

Nail psoriasis is an autoimmune disease that changes the nails. Nail fungus is an infection from fungi. Both can make nails thick, discolored, and separate from the nail bed. But, they show different signs.

Distinguishing Symptoms

Nail psoriasis often shows:

• Nail pitting (small dents or holes in the nail)
• Nail discoloration (yellow-brown or oil drop appearance)
• Onycholysis (separation of the nail from the nail bed)
• Subungual hyperkeratosis (buildup of chalky material under the nail)

Nail fungus, on the other hand, causes:

• Thickening and brittleness of the nails
• Yellow, brown, or white discoloration
• Debris accumulation under the nail
• Foul odor

Diagnostic Tests

To diagnose nail psoriasis or nail fungus, doctors use various diagnostic tests. These include:

• Physical examination of the nails and skin
• Nail clipping or scraping for microscopic analysis and fungal culture
• Skin biopsy to confirm the presence of psoriasis

These diagnostic tests help doctors find the cause of nail changes. Then, they can create a treatment plan for either nail psoriasis or nail fungus.

Preventing Nail Psoriasis Flare-Ups

It’s not always possible to stop nail psoriasis flare-ups, but you can reduce their number and impact. Managing stress and avoiding triggers are key steps. These actions can help lessen the severity of your symptoms.

Stress Management

Stress can trigger psoriasis flare-ups, including nail psoriasis. To prevent this, finding ways to manage stress is vital. Try relaxation techniques like deep breathing, meditation, or yoga. Regular exercise and a healthy diet also help reduce stress and improve your overall health.

Avoiding Triggers

Other things can also make nail psoriasis worse. These include injuries to the nails, exposure to chemicals, and smoking. To avoid flare-ups, identify and steer clear of your personal triggers. Wear gloves for manual tasks and avoid harsh chemicals. Quitting smoking can also help your nail psoriasis and overall health.

By managing stress and avoiding triggers, you can prevent nail psoriasis flare-ups. This helps keep your nails healthier. Always work with your healthcare provider to create a prevention plan that suits you.