Nail psoriasis is a type of psoriasis that causes changes in your fingernails and toenails, which can range from discoloration of nails to alterations in the nail bed. To know more about symptoms, treatments, and home remedies for nail psoriasis, you need to read further.
What is Nail Psoriasis?
Nail psoriasis is a condition that has a physical and emotional impact on an individual and can affect their quality of life.
About 7.4 million people in the United States have psoriasis. (1) This condition can cause your body to produce many skin cells. Psoriasis can occur anywhere on the body, including arms, chests, legs, trunk, and nails.
One study published in the year 2016 has noted that 80% to 90% of people with plaque psoriasis also have nail psoriasis. (2)
As per a research published in the year 2014, 70% to 80% of people suffering from psoriatic arthritis have nail psoriasis, while 5% to 10% of people with nail psoriasis do not have any other type of psoriasis. (3)
Around 35% of people suffering from psoriasis and about 80% of people having psoriatic arthritis, develop nail changes. However, it is unclear why this happens in the case of some people and not with others.
People with nail psoriasis, usually have a rash on other parts of the body as well.
Symptoms Of Nail Psoriasis:
Pitting: The hard surface that forms the top of the nails is called the nail plate. It is made of Keratin cells. In the case of nail psoriasis, the nail plate loses cells. This in turn results in small pits that form on your fingernails or your toenails. We must mention that the pits vary from one person to another.
Some individuals might have only a single pit on each nail, while some might have dozens of pits. These pits can either be shallow or deep.
Changes In Nail Shape Or Thickness: Apart from pitting, one might also notice changes in the shape and thickness of nails if they have nail psoriasis. There might be changes in the nail’s texture. Beau’s lines can form across your nails if you have nail psoriasis.
A weakness of the structures supporting nails can result in your nails to crumble. Besides, your nails can also become thicker because of a fungal infection known as Onychomycosis, which is a common infection in patients with psoriasis
Discolored Nails: If you have nail psoriasis, the color of your nails might even change. You might see a yellow and red patch in the nail bed. This looks like a drop of oil under the nail plate. So, it is named as “oil-drop spot”.
You might also see your fingernails or toenails turning yellow-brown color. Crumbling nails usually turn white.
Nail Bed Separation: Sometimes in the case of nail psoriasis, your nail can also get separated from the nail bed, which is the skin present under the nail plate. This nail bed separation is known as Onycholysis. This separation leaves a space under the nail.
If you suffer from nail psoriasis, you might first notice a yellow or white patch at the tip of your nail. The color eventually goes all the way down to your cuticle.
Bacteria can get into this space under your nail and can result in infection, which can cause the whole nail to turn dark.
Tiny Black Lines In Nail In Tip-To-Cuticle Direction: These tiny black lines in your nail in tip-to-cuticle direction are called as Splinter hemorrhages or dilated tortuous capillaries in the dermal papillae. Such condition occurs when the tiny capillaries in your fingertips bleed between the nail and the skin under your nail.
Spotted Lunula: Redness of the pale arched area or the spotted lunula occurs at the bottom of your nail. This occurs when the capillaries under your nail are congested.
Treatments For Nail Psoriasis:
Topical Medicines: Topical corticosteroids are one of the most common treatments for nail psoriasis. These topical medications are available in forms of creams, ointments, nail polishes, and emulsions. You will typically apply these topical corticosteroids once or twice in a day.
- Corticosteroid injections can be beneficial for treating symptoms, such as nail thickening, ridges, and nail bed separation.
- Calcipotriol, Calcipotriene, and calcitriol are man-made versions of Vitamin D. They help in reducing inflammation and slowing down the production of excess skin cells. These medicines can help you relieve nail thickness by reducing cell buildup under your nails.
- Tazarotene or Tazorac is a topical retinoid that is a medication prepared from Vitamin A and it can be used to get rid of pitting, nail discoloration, and separation.
- An anti-inflammatory ointment known as Anthralin slows excess skin cell production. When you apply this ointment to your nail bed once regularly, it helps in improving symptoms like nail thickening and onycholysis.
- You can also try using moisturizers. Though they do not treat nail psoriasis, however, they can relieve redness and itching and can help the skin around your nails to heal.
Oral Drugs: Systemic drugs, such as methotrexate, cyclosporines, retinoids, and apremilast are available as a pill or liquid, or an injectable medicine. These medications work throughout your body to clear both the skin as well as the nails and are meant for treating moderate to severe psoriasis.
Biologic Drugs: Biologic drugs like entanercept (Enbrel), Adalimumab(Humira), and Infliximab( Remicade) dampen the overactive immune response that leads to psoriasis. You receive such drugs either by infusion or injection. These drugs are typically reserved for psoriasis that does not respond to other treatments.
Phototherapy: Phototherapy is a therapy that exposes the affected areas of skin or nail to Ultraviolet or UV rays from the sun, a phototherapy unit at home or a clinic, and a laser. The light here slows down the growth of skin cells.
For nail psoriasis, you need the treatment called PUVA. Here, first, you have to soak your hands or take a medication named Psoralen. Then you are exposed to the UVA light. Such a type of treatment can be beneficial in treating nail discoloration and separation.
Laser Treatment: Laser therapy might be a useful treatment for nail psoriasis. The type of laser that is used in nail psoriasis is known as Pulsed dye laser or the PDL.
This type of treatment works by targeting blood vessels under your skin with a beam of light, and this appears to reduce the severity in the case of nail psoriasis.
Treating Fungal Infections That Is Associated With Nail Psoriasis: As per the National Psoriasis Foundation, about 1/3rd of people with nail psoriasis, also have a fungal infection. (4) A doctor might prescribe medications for treating both the conditions at the same time.
- If you have a fungal infection, your doctor might prescribe you terbinafine(Lamisil) and itraconazole( Sporanox)
- However, you should note that these drugs might have adverse effects, which might include a skin rash or even liver damage.
- A fungal infection would affect the part of the nail that has already formed; however, nail psoriasis results in problems when the new nail is forming. Topical medicines for psoriasis might never reach this area. So your doctor might prescribe you oral medications.
Home Remedies For Psoriasis:
There are some home remedies, such as garlic or vinegar, that aim to relieve the symptoms of fungus in your nails. However, there is a lack of evidence that suggests that such methods would help.
Home remedies might not have any effect on systemic nail psoriasis. However, you can still try the remedies, but only after consulting with your doctor. Let’s take a look at a few home remedies for psoriasis that you can try.
Cleaning The Nails: Home care and proper hygiene cannot prevent psoriasis, however, they can help ward off infections.
- If you have nail psoriasis, you should keep your fingernails and toenails trimmed and clean to prevent the buildup of bacteria. Trim your nails to the nail bed and file them down.
- For removing dirt from under your nails, soak them in the antibacterial soapy water. Do not clean them using a sharp object.
- You can keep your nails soft by applying moisturizers to your nails and cuticle. Moreover, having soft skin would also help in preventing ingrown nails.
- We would also let you know that if your toenails rub against the top of your shoes, it might lead to jagged and ingrown nails. So you should wear larger shoes and that would help.
Chinese Herbal Medicine: One herbal remedy that could benefit you in nail psoriasis is Indigo naturalis. This is a Chinese herbal medicine that comes from the same plant that is used for making blue dye.
In a small study, an indigo naturalis extract in oil( Lindioil) has shown improvements in nail thickening and onycholysis better than Calicootriene. (5)
Cosmetic Treatments: Some individuals might find the symptoms of their nail psoriasis unsightly and they might also feel embarrassed. In such a case they can turn to cosmetic solutions. Simply, filing and shaping the affected nails might help in improving their overall appearance.
However, you should remember nor to poke the cuticles, as this can worsen your symptoms of nail psoriasis. This might cause an infection and this can lead to a psoriasis flare.
You should also avoid using artificial nails, as the chemicals present in the glue can irritate and even damage the nail bed.
Preventive Measures For Nail Psoriasis:
Some preventive measures that must be followed to prevent nail psoriasis. Let us take a look at some of them.
- Keep short nails to avoid injury or lifting the nail off the nail bed. You should trim your nails daily and that would prevent buildup from collecting underneath them.
- Wear protective gloves while you are gardening or playing sports or when you are washing dishes or even when you are working with your hands in water.
- Clean your nails to prevent infection.
- Do not pick or bite your nails or do not push back your cuticles. Injuries to the skin can set off psoriasis flares.
- Avoid cleansing your nails with a sharp object or a nail brush. This will prevent nail separation.
- Use a moisturizing cream on your cuticles and nails to prevent cracked or brittle nails.
One must keep it noted that nail psoriasis is not contagious and treatments can help in reducing or controlling the symptoms.
So, if you are experiencing any symptoms of nail psoriasis or a fungal infection in your nails, you should see a doctor. This is particularly important for individuals who already have any other type of psoriasis.
Symptoms might improve with treatments and proper nail care. So, do not delay in visiting your doctor if you experience the symptoms of nail psoriasis.