What nail psoriasis is and how to treat it

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Usually, skin cells reproduce every 28–30 days in young adults. People with psoriasis have an overactive immune system, which causes these cells to reproduce every 3–4 days. As a result, some visible skin sections become thick, inflamed, and itchy.

Nails are part of the skin. They grow from the nail root just under the cuticle, where psoriasis affects them. Nail psoriasis is a chronic condition of the immune system. It is an autoimmune condition, meaning the immune system mistakenly attacks the healthy nail tissue.

A person with nail psoriasis may have the following nail problems:

• dents or holes
• white spots
• grooves
• changes in shape or size
• thickening
• onycholysis, separation of the nail from the nail bed
• crumbling
• discoloration
• blood streaks

If the nail becomes detached from the nail bed, an infection can develop in the gap. When this happens, a yellowish patch may form on the tip of the nail and extend to the cuticle.

A chalky substance may develop under the nail, also creating a gap. This condition is known as subungual hyperkeratosis.

The nail may feel uncomfortable or painful when a person applies pressure, and an affected toenail may hurt when wearing shoes. The condition can make it difficult to perform specific tasks, such as sewing.

There is currently no cure for nail psoriasis. However, many treatment options are available.

• Over-the-counter creams and ointments: These medications include corticosteroids such as hydrocortisone. A person may also try aloe vera, jojoba, zinc pyrithione, capsaicin, or salicylic acid with coal tar.
• Prescription creams and ointments: Combinations of the local medications calcipotriene, tazarotene (Tazorac), tacrolimus (Protopic), and clobetasol may help improve mild cases.
• Medications that affect the whole body: These systemic medications require a prescription. Doctors usually reserve them for severe cases, and it can take a long time for the nails to improve visibly. Examples include methotrexate, cyclosporine (Neoral), acitretin (Neotigason), and apremilast (Otezla).
• Biologic drugs: A new class of drugs called biologics may also help treat nail psoriasis. These artificially manufactured medications zero in on parts of the immune system that trigger inflammation. Examples include etanercept (Enbrel), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx), and ixekizumab (Taltz).
• Corticosteroid injections: Intralesional therapy involves a doctor injecting medication into the nail bed. This produces positive results in some people, primarily when used alongside topical treatments. The doctor may use a numbing agent such as a local anesthetic to minimize injection pain.
• Removing the nail: If necessary, a doctor may remove the nail with surgery or X-ray therapy or apply a high concentration of urea in the area. The nail may still have an unusual appearance when it grows back. If infected nails are painful, a doctor may prescribe pain relievers.
• Non-drug treatments: Some people try phototherapy or laser therapy for psoriasis, including nail psoriasis. There are many different types of phototherapy that can be effective. But some wavelengths may increase the risk of skin cancer. Doctors may not recommend these wavelengths for certain people, including those with a high risk of skin cancer.

Fungal infection

Some medications for nail psoriasis may increase a person’s risk of developing a fungal infection. It is possible to have both a fungal infection and nail psoriasis at the same time.

A fungal infection affects the already-formed part of the nail. Nail psoriasis causes issues in the area where the new nail is forming.

Because topical medications for psoriasis may never reach this area, doctors may prescribe oral medications instead. A doctor can prescribe medications to treat both psoriasis and fungal infections at the same time.

If a person also has a fungal infection, a doctor may prescribe terbinafine (Lamisil) or itraconazole (Sporanox). However, these drugs can have adverse side effects, ranging from a skin rash to liver damage.

Certain nail care measures may help relieve symptoms and prevent the area from becoming infected.

For example, while working with the hands, it is a good idea to wear rubber or cotton gloves. This can protect the hands from injury and protect the fingers from harmful bacteria. It can also help protect the nails from corrosive materials such as cleaning agents. However, a person should avoid latex gloves, which can irritate sensitive skin.

The American Academy of Dermatology Association (AAD) recommends that a person with nail psoriasis keep their toenails and fingernails trimmed and clean to prevent bacteria from building up and refrain from cleaning the nails with a sharp object. If having a manicure, a person should request that the manicurist does not push back or touch the cuticles.

As much as possible, a person should avoid biting or picking their nails or the surrounding skin.

Rubbing moisturizers into the nail and cuticle helps keep the nails soft. A pharmacist or healthcare professional can advise about suitable products that help prevent the hands, feet, and nails from becoming too dry. A thick, fragrance-free product is best.

Nail psoriasis is not contagious. Treatment can reduce or help manage the symptoms.

If the nails show symptoms of psoriasis or fungal infection, a person should contact a doctor. This is especially important for people who already have a type of psoriasis.

A person may have to try several treatments before finding one that works. Symptoms can take time to improve and may take a long time to clear. One reason for this is that the nail plate grows very slowly. It’s also important to know that the symptoms may return later on.

With new drugs being approved and entering the market, more effective treatments for nail psoriasis may be on the horizon.

There is currently no cure for psoriasis. Anything that irritates the skin can cause the condition to flare up. The AAD offers the following advice to help avoid flare-ups whenever possible:

• protect the skin from sunburn
• use a cold compress
• moisturize regularly
• avoid scratching
• avoid stress as much as possible
• avoid skin injuries, such as cuts and bug bites

Below are answers to some commonly asked questions about nail psoriasis.

Can I hide nail psoriasis?

If a person wants to hide the effects of nail psoriasis, they can talk with a dermatologist about the best options.

Sometimes using nail polish or having a professional manicure might help, though a person should take care not to touch the cuticles and be sure to tell their nail technician about their condition.

A person may want to consider using nail polish and nail polish removers designed for people with sensitive skin that do not contain the harsh chemicals that regular products do.

Does nail psoriasis spread?

Unlike a fungal infection, nail psoriasis does not spread through contact. Without treatment, nail psoriasis may get worse. In severe cases, it may become difficult for a person to use their hands or feet because of the discomfort that nail damage causes.

Is there a cure for nail psoriasis?

There is currently no cure for nail psoriasis, but treatment options are available that may make living with the condition more comfortable. There are many ways to avoid or manage flare-ups that offer support for psoriasis ranging from mild to moderate to severe diagnoses.

It is important to know that symptoms may take up to a year to clear.

How does nail psoriasis look on skin of color?

People of Color with nail psoriasis may develop what looks like small pinpricks on the nail. The nails may also become thicker, crumble, and develop discoloration. Nail psoriasis can mimic other conditions. Often, a doctor may need to order a biopsy to identify nail psoriasis over other causes.

Nail psoriasis does not always cause physical pain but may cause discomfort and embarrassment. Doctors often use a scoring system to help determine the severity of symptoms. Treatment can prevent the condition from worsening.

Nail psoriasis can resemble a fungal infection, making diagnosis difficult. Getting a correct diagnosis is important because the treatment for a fungal infection is different from nail psoriasis treatment.

Doctors typically recommend that people with psoriasis who experience nail changes make sure their doctor is aware of their psoriasis.

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