Importance Of The Nail In Psoriasis
Despite its frequent occurrence, nail psoriasis is often overlooked and not treated effectively. This has important implications for the management of patients with psoriasis, since nail involvement has a serious negative impact on functioning and quality of life. Furthermore, it may be a predictor of future inflammatory joint damage, a precursor to PsA, and a visible indicator of disease activity.
Overview Of Nail Psoriasis
Psoriatic nail disease has many clinical signs. Most psoriatic nail disease occurs in patients with clinically evident psoriasis it only occurs in less than 5% of patients with no other cutaneous findings of psoriasis.
An estimated 10-55% of all patients with psoriasis have psoriatic nail disease, and approximately 7 million people in the United States have psoriasis. About 150,000-260,000 new cases of psoriasis are diagnosed each year. US physicians see 1.5 million patients with psoriasis per year.
Severe psoriatic nail disease can lead to functional and social impairments if left untreated.
See the images of psoriatic nail disease below.
See 15 Fingernail Abnormalities: Nail the Diagnosis, a Critical Images slideshow, to help identify conditions associated with various nail abnormalities.
For patient education information, see the Psoriasis Center and Arthritis Center, as well as Psoriasis, Types of Psoriasis, Understanding Psoriasis Medications, and Psoriatic Arthritis.
Management Of Nail Psoriasis
Management of the disease includes patient education, avoidance of trauma to the nails, and different therapeutic approaches with physical and pharmaceutical procedures and agents.
Patient counseling includes education on the nature of psoriasis, how life may be influenced by nail involvement, about the specific problems of treatment, that nail psoriasis is not due to an allergy or an unhealthy diet and thus is not treatable with particular foods. However, smoking increases the risk of psoriasis and obesity and alcohol use are associated with a higher risk for psoriasis. It is important to avoid trauma to the nail unit that will inevitably exacerbate the condition or induce recurrences. Manicure and nail cleaning have to be performed cautiously without further traumatizing the hyponychium and attachment of the nail to the nail bed. It is helpful to explain that genes are the most important etiological factors and that the skin and nail lesions are amenable to treatment but that the genes cannot be corrected. Many genes contribute to the psoriatic personality, which may explain the enormous variability of the clinical features including the response to treatment. Particularly, chronic repeated trauma is thought to be an aggravating factor. The development of pits may be the result of microtraumata to the enthesis of the extensor tendon and the dorsal aponeurosis of the distal interphalangeal joint. They may be masked using nail varnish.
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Beyond The Skin And The Nail
Nail psoriasis is considered a precursor of a severe inflammatory joint disorder. There is a positive association between nail psoriasis and the severity of joint involvement. Nail psoriasis is also correlated with enthesitis, polyarticular disease, and unremitting progressive arthritis. High-resolution magnetic resonance imaging studies have found that psoriatic arthritis related DIP joint inflammatory reaction is very extensive which frequently involves the nail matrix and often extends to involve the nail bed. This is mainly due to the attachment of fibers of ligaments and tendons of DIP joint close to the matrix. The presence of joint or nail symptoms may indicate a severe form of psoriasis, and this will affect how the disease is managed. It is important, therefore, for dermatologists to be aware of the early symptoms of psoriatic arthritis, particularly in patients with nail psoriasis, in order to avoid progressive joint damage.
Group Gr And Group It Epidemiological Data
A total of 68,839 children aged 6-17 years were seen in pediatric skin consultation over a period of 10 years at both clinics . The number of patients/year is shown in figure 2. The total number of patients at the pediatric age affected by skin psoriasis was 406 , 284 in Group GR and 122 in Group IT, corresponding to 0.9 and 0.31% of the pediatric population, respectively. Furthermore, a total of 74 out of the 68,839 children had involvement of the nails: 55 out of 30,044 in Greece and 19 out of 38,795 in Italy, which equals 0.18 and 0.05% of all pediatric skin consultations, respectively . With regard to the children with skin psoriasis, the rate of children affected by nail psoriasis was 19.4% in Group GR and 15.5% in Group IT.
Table 2
For additional information:
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How Do You Stop Psoriasis From Spreading
Psoriasis does not spread from one person to another because it is not contagious. However, it is possible for the condition to spread to new areas of your bodyespecially when psoriasis is not being correctly untreated. Depending on which kind of psoriasis you are suffering from, your rash and redness could appear in a number of areas of the body.
In most cases of plaque psoriasis, people notice their outbreaks occurring near the scalp, knees, or elbows. But psoriasis can spread throughout different areas of the body over time. The best way to keep your psoriasis under control and from spreading is to consult with your dermatologist. Under the care of a professional skin care provider, youll be able to determine the best solution for your particular skin condition and personal needs.
How Do You Treat Nail Psoriasis
There is no complete cure for nail psoriasis one can only use a prolonged treatment regimen in order to keep this fingernail disorder under control. Psoriasis treatment includes the following:
- Topical creams: These are an array of creams or gels that can be directly applied to the nails without any supervision. The ointments contain extracts of Vitamin A, Vitamin D and Calcipotriol . The only limitation with this treatment would be that the contents of the cream do not reach the nail matrix as the cuticle forms a thick barrier. Over months of treatment, the barrier thins down.
- Antifungal treatment: Antifungal treatment is prescribed when nail psoriasis worsens due to a fungal infection.
Regardless of the type of treatment option, it is important to stay patient. These treatment plans work on the new nail and the process of outgrowing the defected nail takes at least a year for fingernails and twice as much for toe nails.
Psoriasis of the nails affect the dexterity and overall functioning of ones hands. It is always better to take simple steps to prevent this nail disorder than battle it later.
Prevention tips:
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What Treatments Are Available For Nail Psoriasis
There are many treatments for nail psoriasis. Your treatment plan may include one or more of the following.Treatment you apply to the nails: This can be helpful for mild or early nail psoriasis. Nails grow slowly, so youll need to apply these treatments for several months, often once or twice a day. Because nail psoriasis can be stubborn, you may need to use more than one treatment. Sometimes, two medicines are combined to give you a faster response.
Treatment that you apply to your nails includes the follow.
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A potent or very potent corticosteroid: This can be helpful for most signs and symptoms of nail psoriasis. Its safe to use this medicine once or twice a day for up to nine months.
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Calcipotriol: In one study, researchers found this to be as effective as a potent corticosteroid at treating the buildup beneath the nail.
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Tazarotene: This treatment can be especially helpful for treating pitting, a separating nail, and discoloration.
If you need stronger treatment, your dermatologist may recommend treatment given in a dermatologist office or clinic. This treatment may include one of the following.
Psoriasis medicine that can help clear the skin and nails includes:
-
A biologic
What Your Nails Can Tell Your Doctor About Psa
The risk of psoriatic arthritis may be evident in your fingernails and toenails.
Iâve had a complicated relationship with my nails all my life, but I pushed the symptoms aside with a shrug, thinking that my nails just didnât grow. A mani/pedi outing with the girls was always just a pedicure for me and then waiting for the others to finish getting manicures or acrylic nails put on. âWhatâs the point?â I would say to myself. âI donât have any nails to manicure, and they feel heavy enough as is.â
It wasnât until my rheumatologist was inspecting my hands that I learned there was a connection between my psoriasis, psoriatic arthritis and the condition of my nails.
The nail is composed of three main parts: the nail plate , the nail bed and the nail matrix . The part of the nail affected will determine the symptoms that show in your nail. Pits, horizontal lines, deformity, discoloration, onycholysis , brittle nails that crumble or splinter, and thickening of the nails can all be signs that nail psoriasis is present.
Apart from my pinky fingernails, every one of my fingernails is affected by nail psoriasis in some way, shape or form. My thumbnails feel heavy and have V-shaped peaks, horizontal ridges, cuticles and hangnails that crack and bleed. My ring, middle and index fingernails are brittle, have splinter hemorrhages and break in a way that reminds me of peeling away the layers of a biscuit.
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Psoriasis Can Affect Both Fingernails And Toenails
Psoriasis can affect both fingernails and toenails, with half of those with psoriasis alone having some form of nail involvement. The risk increases in those with psoriatic arthritis, and it is reported that this could be as high as 4 out of 5 people seeing changes to their nails. For some unknown reason fingernails are more often involved than toenails. For many people, nail psoriasis is often mild and causes few problems.
The nails are part of the skin, so it is perhaps not surprising that a skin disease such as psoriasis can affect the nails. No one knows why some people get nail involvement and others dont. Nails grow from the nail root , which is just under the cuticle. In people who develop nail psoriasis it is involvement of the nail root that causes pitting and ridging of the nails.
Onycholysis , subungual hyperkeratosis and splinter haemorrhages are all caused by disease of the nail bed. These conditions are explained in the next section.
The nail is made of modified skin and, once it has grown, it can only be altered by filing or clipping. Treatments are usually directed at the nail bed that supports the nail or the nail folds that tuck around the edges. Soothing these tissues can result in better nail growth with fewer features of psoriasis.
What changes can occur with nail psoriasis?
These are the most common changes in nail psoriasis:
What can be done about it?
Tips on general nail care
Medical treatments for nail psoriasis include:
How Often Does Psoriatic Arthritis Affect The Nails
Psoriasis limited to the nails is uncommon and estimated to occur in only 5-10% of people with psoriasis, although many people who first present with psoriasis only in their nails later develop psoriasis of the skin and/or joints. Nail psoriasis is more likely to occur in adults than children.1
Psoriasis of the skin, scalp and/or nails often occurs before the appearance of PsA, and psoriasis of the nails has been associated with a greater likelihood of developing PsA. Nail lesions occur in about 87% of people with PsA.2
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Epidemiological Data From The Literature
The 16 selected papers encompassed data on a total of 4,853 psoriatic patients at the pediatric age, of whom 762 had nail involvement . In all published papers, the average observation period was extremely long, ranging from 1.5 to 30 years. Noteworthy are the huge discrepancies in nail psoriasis rates, ranging from 0.6 to 79% of the infants.
Table 1
Prevalence of nail psoriasis in children based on previously published data
The prevalence of pediatric nail psoriasis in Caucasian patients was evaluated by selecting the papers coming from Europe, the US and Australia. A total of 343 pediatric patients out of 3,355 individuals affected by psoriasis had nail involvement. In the subgroup of European patients, a total of 165 patients out of 1,318 children with psoriasis were diagnosed with nail psoriasis. Considering the observation period, the average number of children diagnosed with nail psoriasis was 5.6/year.
Will Good Dietary Nutrition Help My Psoriasis
A healthy diet is important for well-being and can reduce your risk of many long term illnesses, including coronary heart disease, inflammatory conditions and even cancer. However there is no clear link between what you eat and the severity of psoriasis symptoms.
- The British Nutrition Foundation suggests eating at least 300g oily fish per week for general health . Fish oil has been shown to benefit psoriasis
- Aim to eat more green leafy vegetables, nuts, seeds and wholegrain cereals which also contain important essential fatty acids.
- Cut back on saturated fats and vegetable oils and use more olive oil and rapeseed oil products
- Eat fresh home made foods rather than pre-packaged, convenience foods
- Certain foods may worsen your symptoms. If you experience any adverse effects from foods it may be worth making a note of these to discuss with your doctor and generally for your own avoidance when preparing and eating food
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Clinical Manifestations Of Nail Bed Psoriasis Include
Oil spot or salmon patch
They result from focal nail bed parakeratosis which leads to focal onycholysis, where serum and cellular debris accumulate and become entrapped. There is usually a yellowish brown margin visible between the white oily spot or salmon patch lesion and the normal pink nail. Extension of an oil spot to the distal free edge leads to onycholysis .
Onycholysis along with salmon patches on thumbnails in a patient with psoriasis
Onycholysis
Results from psoriasis affecting the distal nail bed or hyponychium or extension of oil spots distally. Onycholysis allows air to enter the distal end of the nail plate leading to white color .6]. Serum exudates may accumulate and appear yellowish.
Onycholysis along with pitting and salmon patches in fingernails
Subungual hyperkeratosis
It affects the toenails more frequently than the fingernails. It results from raising of the nail plate off the nail bed as a result of deposition of cells that have not undergone desquamation .b]. This accumulated tissue is friable and is liable to be infected by Candida and Pseudomonas leading to either yellow/green discoloration.
Nail plate thickening with discoloration and subungual hyperkeratosis of the toenail Subungual hyperkeratosis affecting toenails
Splinter hemorrhages
Does Psoriasis Ever Go Away For Good
Psoriasis is a chronic skin condition that is not curable and it will not go away on its own. However, the disease fluctuates and many people can have clear skin for years at a time, and occasional flare-ups when the skin is worse.
Research has shown that psoriasis is an autoimmune disease . This means your immune system, which usually protects your body from getting sick, has become too active, causing symptoms like plaques, redness, and those flakes that feel like they go wherever you do.
There are times when you may go several weeks without experiencing any patches, and it may feel like you are finally done dealing with psoriasis for good. Unfortunately, it does not go away for good. It may come back several days or even weeks later.
Guttate Psoriasis Go Away A 38-year-old man presented with symptoms of fever and dry cough. There was a past medical history of chronic plaque psoriasis with a single active psoriatic. How To Make Guttate Psoriasis Go Away For scalp psoriasis. Comb the hair to remove any loose scales. Shake the can for a few seconds before use and remove
Psoriasis is a chronic skin condition that is not curable and it will not go away on its own. However, the disease fluctuates and many people can have clear skin for years at a time, and occasional flare-ups when the skin is worse.
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When Should Someone Seek Medical Care For Nail Psoriasis
If there are changes in the nails such as discoloration or pits or if the nails seem infected or are painful, see a doctor.
At present, psoriatic nail disease does not have a cure. The goal of treatment is to improve the function and appearance of psoriatic nails. If the nails have a fungal infection, a doctor will prescribe an antifungal medication.
Can Psoriasis Affect Only My Nails
In some cases, psoriasis may involve only the fingernails and toenails, although more commonly, nail symptoms will accompany psoriasis and arthritis symptoms. The appearance of the nails may be altered, and affected nails may have small pinpoint pits or large yellow-colored separations on the nail plate called oil spots. Nail psoriasis can be hard to treat but may respond to medications taken for psoriasis or psoriatic arthritis. Treatments include topical steroids applied to the cuticle, steroid injections at the cuticle, or oral medications.
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Generalised Pustular Psoriasis Or Von Zumbusch Psoriasis
This causes pustules that develop very quickly on a wide area of skin. The pus consists of white blood cells and is not a sign of infection.
The pustules may reappear every few days or weeks in cycles. During the start of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue.
Plaque Psoriasis: The Rash That Didnt Go Away
According to a study by the Journal of the American Academy of Dermatology around 7.4 million adults are affected by psoriasis in the U.S. and while there are actually five different types of psoriasis you can be affected by, we will concentrate on the most common form of psoriasis, known as plaque psoriasis. The AAD estimates that about 80% of people with a psoriasis condition experience plaque psoriasis.
Just what exactly is plaque psoriasis though?
Plaque Psoriasis is a chronic autoimmune disease which causes your skin production to speed up faster than old skin can slough off. This causes your skin to start building up as scales, adding layer upon layer on your skins surface. For someone without the disease, skin cells normally grow deep within your skin, rise slowly to the surface of your skin, and then slough off ,with a typical life cycle being about a month. But if you have psoriasis, the production occurs in just a few days, which doesnt give the skin cells time to fall off, and thats what leads to the build-up of skin cells, or psoriatic scales, which are whitish-silver in color on Caucasian skin, and develop in thick red patches that are typically inflamed and sometimes will crack and bleed . These plaques are often very itchy and sometimes painful.
What areas does plaque psoriasis affect?
Whos at risk?
Noticing the symptoms
The symptoms of plaque psoriasis are different for everyone, but have some common signs you can look for. These include:
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