Nail Psoriasis
Nail psoriasis is an autoimmune condition. It causes discoloration, pitting and changes in your fingernails and toenails. There isn’t a cure, but treatments can alleviate related symptoms.
Nail psoriasis is an autoimmune disease that causes your skin cells to reproduce quickly. It’s a type of psoriasis that affects the nails on your fingers and toes.
Nail psoriasis typically appears along with a psoriatic rash on other parts of your body.
Who does nail psoriasis affect?
Anyone can get nail psoriasis. However, you may be more likely to develop nail psoriasis if you:
Are over 40 years old.
Are male.
Have psoriasis or a family history of psoriasis.
Have psoriatic arthritis.
Nail psoriasis is an immune system problem. Typically, new skin cells grow every 28 to 30 days. However, in people with psoriasis, new cells grow and move to the skin surface every three to four days, which creates a skin rash. In some people with psoriasis, it affects their nails in addition to their skin or other parts of their bodies.
Symptoms of nail psoriasis include:
Discoloration: The skin underneath your nails (nail bed) may change colors. These changes, called salmon patches or oil drop spots, may look yellow, red, pink or brown.
Pitting: Your nails may develop dents or pits (cupuliform depressions). They can be as small as the tip of a pin (0.4 millimeters) or as large as the tip of a crayon (2 millimeters), and they can be shallow or deep. You may only have one or two pits on your nails, or you may have more than 10 per nail.
Changes in nail structure: You may develop grooves that run horizontally across your nails (Beau’s lines). Your nails may grow so thin that they start to crumble. The thick layer of skin underneath the tip of your nail may also start to peel and slowly separate from the nail bed (onycholysis), which may lead to the development of nail fungus.
How is nail psoriasis diagnosed?
Your healthcare provider can typically diagnose nail psoriasis after a physical exam. They’ll examine your affected areas to look for common signs of nail psoriasis. They’ll also ask about your symptoms and your family history.
Once your healthcare provider has diagnosed nail psoriasis, they may use the nail psoriasis severity index (NAPSI) to grade its severity. The NAPSI uses imaginary lines to divide your nail into four even sections (quadrants). Your nails receive a 0-4 score based on the presence of any nail psoriasis symptoms in each of the quadrants. Your healthcare provider will then add the scores together. A low number means your nail psoriasis is mild, and a high number means your nail psoriasis is more severe.
People with nail psoriasis may develop a number of symptoms. Providers use NAPSI to determine the severity of the condition.
Can nail psoriasis go away on its own?
There isn’t a cure for nail psoriasis. It’s a long-lasting (chronic) condition, which means flare-ups can occur throughout your life. You may have flare-ups and times when the symptoms go away (remission). Treatments can provide relief for your symptoms.
How do you treat nail psoriasis?
Nail psoriasis is often resistant to some treatment options, so it can be challenging to manage without standard treatment. You and your healthcare provider may have to explore different treatment options, including:
Corticosteroids: Your healthcare provider may prescribe a corticosteroid cream, ointment or nail polish. For corticosteroids to effectively treat your nail psoriasis, they must reach the nail bed and the area of your fingers where the nail starts to grow (nail matrix), which can be difficult. You may have to apply the medication up to twice a day, and you may not see noticeable improvement until at least four to six months.
Medicine injections: In more serious cases of nail psoriasis, your healthcare provider may use a thin needle to inject medicine into the skin around your nails. These medicines may include etanercept, adalimumab or ustekinumab.
Oral medicines: In more serious cases of nail psoriasis, your healthcare provider may prescribe liquid medicines or pills or tablets that you swallow with water. These medicines may include methotrexate, cyclosporine or apremilast.
Phototherapy: Phototherapy uses ultraviolet light from special lamps. Your healthcare provider may use a drug called psoralen combined with ultraviolet A (PUVA) or ultraviolet B (UVB). The ultraviolet light waves in phototherapy can help certain skin and nail disorders, including nail psoriasis.
Laser therapy: Your healthcare provider may use a pulsed dye laser (PDL) to target the blood vessels under your nails, which may reduce the severity of nail psoriasis. Laser therapy treatments usually occur every six months.
Nail psoriasis isn’t contagious. You can’t spread nail psoriasis to another person through skin-to-skin contact.
What can I expect if I have nail psoriasis?
Nail psoriasis may flare up and go into remission throughout your life. However, it can generally be well managed with treatment.
How do I take care of myself?
If you have nail psoriasis, the best way to take care of yourself is to:
- Take medications or apply treatments as instructed.
- Regularly clean, trim and moisturize your nails, and protect your nails from harm.
How can I reduce my risk of developing nail psoriasis?
There isn’t any way to prevent nail psoriasis. If you have nail psoriasis, it may come and go throughout your life. Treatments can reduce symptoms, even in people with severe nail psoriasis.
If you have nail psoriasis, you may be at a higher risk of:
Diabetes.
Heart attack.
High cholesterol.
Obesity.
Stroke.
References
- Haneke E. Nail Disorders. In: Kang S, Amagai M, Bruckner AL, et al., eds. Fitzpatrick’s Dermatology. 9th ed. McGraw Hill; 2019.
- Jefferson J, Rich P. Nail Disorders. In: Kelly A, Taylor SC, Lim HW, et al., eds. Taylor and Kelly’s Dermatology for Skin of Color. 2nd Edition. McGraw Hill; 2016.
- Mayeaux, Jr. EJ. Psoriatic Nails. In: Usatine RP, Smith MA, Mayeaux, Jr. EJ, et al., eds. The Color Atlas and Synopsis of Family Medicine. 3rd Edition. McGraw Hill; 2019.
- Nardo VD, Gianfaldoni S, Tchernev G, et al. Use of Curcumin in Psoriasis (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816303/). Open Access Maced J Med Sci. 2018; 6(1): 218-220. Accessed 4/25/2022.
- Schons KR, Knob CF, Murussi N, et al. Nail Psoriasis: A Review of the Literature (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008063/). An Bras Dermatol. 2014; 89(2): 312-317. Accessed 4/25/2022.
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