Tips for Dealing With Nail Psoriasis

As with all types of psoriasis, nail psoriasis is caused by inflammation, says Marisa Garshick, MD, an assistant clinical professor of dermatology at NewYork-Presbyterian / Weill Cornell Medical Center and a dermatologist at MDCS Dermatology in New York City. That inflammation can impact the nail matrix — the area beneath the cuticle where the nail starts — which can affect how the nail grows out. The soft tissue underneath the nail (the nail bed) can also be affected, as can the skin around the nail, which can easily be mistaken for other nail conditions, such as an injury to the affected nails or a fungus.

Nail psoriasis symptoms largely aren’t painful, just noticeable, although “Some people can experience tenderness or sensitivity,” says Dr. Garshick. The symptoms of nail psoriasis can include:

• Nail pitting This refers to tiny dents that form on the surface of the nail.
• Nail crumbling The nails themselves can start to break apart, which can affect day-to-day functions such as using a computer keyboard.
• Onycholysis, or lifting of the nail away from the nail bed Thickening of the nail can cause it to separate from the finger or toe, which makes it more likely to catch on something and lift up or break off.
• Leukonychia, or tiny white dots on the surface of the nail Inflammation causes this discoloration.
• Salmon spots or oil spots Yellow-red discolorations form on the nail bed and look like a drop of oil under the nail.

These symptoms can appear on fingernails, toenails, or both, but not every fingernail or toenail may be affected. If you notice any of these or other concerning nail symptoms, see your doctor or a dermatologist.

Nail psoriasis and nail fungus both affect the look and feel of your nails, making them brittle, discolored, or detached from the nail bed. For that reason, it can be difficult to distinguish nail psoriasis from a fungal infection — it’s also possible to have both at the same time.

Their causes, however, are different. Fungal infections are contagious and the result of fungi getting between the nail and the nail bed. This may happen in a warm, moist environment like a locker room or a pool deck.

Signs of psoriasis elsewhere on the body, such as your scalp, elbows, knees, and lower back, would suggest that the nails are also involved in the condition.

Fungal infections are curable, with a topical or oral antifungal medication.

• Topical Treatments?These include strong corticosteroids, calcipotriol (which is derived from vitamin D), and?tazarotene (derived from vitamin A). These are applied once or twice a day.

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• Injections of corticosteroids or another psoriasis medications such as etanercept, adalimumab, or ustekinumab. Methotrexate may also be injected. Your dermatologist injects medication directly into the skin around the nail.

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  Most patients receive a series of injections, which are given every four to six weeks.

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• Systemic Treatments For more severe nail psoriasis, oral medications that work throughout the body may help. These include methotrexate, the TNF inhibitor apremilast (Otezla), biologics like the IL-17 inhibitor ixekizumab (Taltz), the oral TYK2 inhibitor deucravacitinib (Sotyktu), the retinoid acitretin (Soriatane), or the calcineurin inhibitor cyclosporine.

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• Laser Therapy A pulsed dye laser (PDL) targets the blood vessels under nails, which may reduce the severity of symptoms. Treatment is typically every six months.
• Phototherapy Ultraviolet light waves can help with nail psoriasis. The drug psoralen may be combined with ultraviolet A rays (PUVA).

There are a few home remedies and lifestyle changes that may help ease symptoms.

Good nail hygiene is important for keeping your hands healthy when you have nail psoriasis. These tips can help:

1. When clipping your nails, trim them short, but be careful not to nick the skin around them.
2. It’s okay to buff your nails, but be gentle. Create as little friction as possible.
3. Manicures are fine, as long as you don’t have any open areas of skin around your nails. “Harsh chemicals should be avoided, as this will dehydrate the nail plate further and strip the natural oils from the nail,” says Alison Angold, an aesthetician and manicurist based in London who has clients with nail psoriasis.
4. Skip acrylics and other artificial nails, which tend to damage the natural nail. It’s okay to wear polish once in a while, but keep in mind that nail polish remover can be drying: Look for brands with added oils.
5. Leave cuticles alone. Cutting them or pushing them up may lead to infection.

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6. Above all, moisturizing will help keep your nails healthy. “The more moisture we can add to the nail and cuticle,” Angold says, “the better the nails will look.” Garshick adds, “Using a petrolatum-based ointment to provide a protective layer over the nail at bedtime can be helpful.”

Finally, nail psoriasis can take years to develop. “Your fingernails and toenails can take anywhere from 6 to 12 months to grow out fully,” Garshick says. Once you’re diagnosed with psoriasis or psoriatic arthritis, it’s important to stick to your treatment plan. Doing so may be all it takes to prevent the condition from creeping into your nails.

For people with skin psoriasis, nail symptoms can also be a sign of psoriatic arthritis, according to Garshick. For that reason, if you have skin psoriasis and notice changes to your fingernails or toenails, it’s important to see your dermatologist right away.

When psoriasis affects your nails, it can be more than unsightly; it can interfere with daily tasks and even lower your quality of life. Keep an eye on your nails for symptoms like pitting or crumbling. Treatment can involve medication, as well as gentle self-care practices like trimming nails short and moisturizing them. Regular care and attention can significantly improve how well you manage nail psoriasis symptoms.