What is Nail Psoriasis & How Can It Be Treated?

Psoriasis is an autoimmune skin condition presenting patches of raised, red skin with silvery scales. These scales are due to a build-up of extra skin cells. It can occur anywhere in the body including chest, arm, legs, trunk, and nails.

Nail psoriasis leads to changes in the fingernails and toenails and causes discoloration of nails and alteration of the nail bed.

According to a study, 70-80 percent of people suffering from psoriatic arthritis have nail psoriasis.¹

Psoriasis tends to run in the family. 40 percent of people with psoriasis have first-degree relative suffering from this condition. And if both the parents have psoriasis the risk rises to 75%.

• Psoriasis can affect people of any race.
• Both male and female are at equal risk.

Signs of psoriasis of nails are similar to those of fungal infection of the nails. Therefore if the patient doesn’t have any symptoms of psoriasis on the skin, it becomes difficult for the doctor to diagnose the condition. It is important to inform the doctor of any family history of psoriasis if present.

The following signs are seen on the psoriatic nails.

The nail plate which forms the top of the nails is made of keratin cells. These cells of the nail plate get damaged. This leads to pitting of the fingernails or the toenails.

The number and density of pitting vary from person to person.

In some individuals, the nail gets separated from the nail bed (the skin under the nail plate). This is known as onycholysis. It starts from the tip of the nail and extends towards the root. This causes an empty space under the nail which can lead to infection, due to bacterial infestation. This can result in the nail turning all black.

There is a change in the texture of the nails. Beau lines (lines or furrows growing across the nails) can form across the nails. The weakness of the support to the nails can cause the nail to crumble.

In some, the nails thicken up due to a fungal infection known as onychomycosis. It is very common in people with psoriasis.

Nail discoloration is a common symptom of nail psoriasis. Yellow-red patches are seen on the nail bed also known as an oil-drop spot or salmon patch.

The appearance of the tiny black line in the tip to cuticle direction is known as splinter hemorrhages or dilated tortuous capillaries. They occur as the tiny capillaries at the tip of the finger bleed between the nail and the skin under the nail.

Most of the people affected with nail psoriasis suffer from psoriatic arthritis well.

Getting a correct diagnosis is very important for the treatment, as nail psoriasis resemble fungal infection of nails and the treatment of both are very different.

The treatment options of nails psoriasis include,

• Anti-inflammatory drugs, which are infused or injected
• Steroid prescription for topical application. Injecting steroid under the nail can be more effective
• Antifungal to treat the fungal infection caused due to nail psoriasis
• Systemic therapy is appropriate if symptoms are severe and persisting. In this therapy, a pill or an injectable which spreads throughout the body is given.
• Removal of the affected nail
• Phototherapy, which involves exposing the affected area to UV rays

• When taking treatment it is important to take special care of the nails at home.
• Keep the nails trimmed so that they do not get stuck and rip off.
• While working with hands wear cotton gloves to protect the nails from injury.
• Wear rubber gloves while washing dishes
• Do not clean nails with a brush or a sharp object
• Keep the nail and the cuticles moisturized. This can prevent them from cracking.