Keeping Nails In Good Shape
In addition to following your doctor’s recommendations for treatment of nail psoriasis, there are other ways to take care of your nails:
- Keep your nails trimmed as short as possible.
- Wear gloves when you’re working with your hands.
- Wear shoes with plenty of room in them.
- Avoid scrubbing or scraping underneath your nails.
- Use gentle nail-cleaning tools.
- Soak your nails in tar bath oil mixed with water, then apply nail moisturizer.
- If your nails are intact, consider using a nail hardener to improve their appearance.
Newer Biologics Available To Treat Nail Psoriasis
Beyond that, we can offer biologic drugs, says Dr. Kassouf. A systemic approach to treatment can be worthwhile, because many patients with skin psoriasis also have nail psoriasis, and both conditions increase the risk of psoriatic arthritis.
More recently, a two-year study of the oral drug tofacitinib in over 1,800 patients with moderate-to-severe nail psoriasis showed significant improvement at four months that continued through one year.
What Is The Outlook For Psoriatic Nail Disease
Psoriatic nail disease can be difficult to treat and there is no cure. It doesn’t usually grow out without treatment, so can continue to cause problems. The appearance of the affected nails can also sometimes cause distress.
The treatment of severe psoriatic nail disease is now improving with modern medicines.
Psoriatic nail disease can also be mild, not needing any treatment, and able to be hidden with nail varnish.
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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.
Symptoms Of Nail Psoriasis
You’ll know you’re getting nail psoriasis when you see these changes in your fingernails or toenails:
- Color. Your nails may turn white, yellow, or brown. They may also have small red or white spots underneath.
- Surface appearance. You may get ridges or grooves in your nails, or pitting on the nail surface.
- Debris buildup. Chalky white material can gather under your nail, causing it to lift away from the skin. This can be painful.
- Thickening. About a third of people with nail psoriasis can also get a fungal infection that can cause your nails to get thick. They may also get brittle and break.
- Your nail may loosen or separate from the nail bed.
Some of these nail changes can make it hard to move your fingers and toes. You may also get tenderness and pain in your nails. This can make it hard to do things with your hands.
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What Are Nail Psoriasis Causes And Risk Factors
Psoriasis is not contagious. How psoriasis of the nails develops is not completely known. Nail involvement appears to result from a combination of genetic , immunologic, and environmental factors.
Psoriasis tends to run in families. About 40% of people with psoriasis have a first-degree relative who is known to have the condition. If both parents have psoriasis, a person’s risk is up to 75%. Males and females are equally likely to have psoriasis. Psoriasis can occur in people of all races.
How To Treat Nail Psoriasis Medically
The most popular medical nail psoriasis treatment is the use of topical steroids. As far as topical steroids are concerned, you are supposed to massage a steroid ointment into the nail plate. The risk associated with this treatment is the thinning of the cuticle because of the fine blood vessels. Also, results are not consistent. Steroids can be injected under the nails. This method is normally painful and the doctor may be required to inject you with a local anesthetic prior to the procedure. Not highly recommended, though.
Nail removal is the next medical approach. The most painlessly way of removing damaged nails involves a number of things. To begin with, the nails have to be applied with urea . What happens is that the nails will loosen up and they can effortlessly be unwrapped off. Your physician can use surgery or X-ray to remove the nails. The only problem with this method is that the nails may regrow deformed.
The next medical treatment for nail pitting psoriasis is systemic treatment. This option is considered when the condition has worsened. Usually, the patient will have difficulty using his or her feet and hands. The patient may be completely unable to walk or using the hands to do anything productive.
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Overview Of Treatment Of Nail Psoriasis
Many treatment options are available after the diagnosis of nail psoriasis is made. The treatments focus on improvement of the functional and psychosocial aspects of psoriatic nail disease.
The treatment options for nail psoriasis include topical corticosteroids, intralesional corticosteroids, psoralen plus ultraviolet light A , topical fluorouracil, topical calcipotriol, topical anthralin, topical tazarotene, topical cyclosporine, avulsion therapy, and systemic therapy for severe cases. Onychomycosis requires antifungal therapy for improvement. Laser and light therapies have emerged as possible cost-efficient, in-office treatments however, large-scale trials are needed, particularly in consideration for the effects in combination with other current therapies.
For preventive care, keep the nails dry and protect them from trauma to avoid the Koebner effect and possible secondary microbial colonization. In areas of onycholysis, the nail plate should be trimmed to the point of separation for medications to be effective.
At present, no definitive and curative treatment has been agreed upon by medical experts. Discuss all treatment options for psoriatic nail disease with the patient, and choose the best individually tailored regimen.
What Are The Symptoms Of Psoriatic Arthritis
If you are experiencing joint pain and have a history of psoriasis, it may be a good idea to visit a doctor to see if you have psoriatic arthritis. In addition to joint pain, some of the more common symptoms of psoriatic arthritis include:
- Swollen and red joints
- Joints that are warm to the touch
- Nail pitting and other changes such as nails lifting from the nail bed
- Stiff joints, especially when first waking up or after long periods of rest
- A general feeling of fatigue or malaise
- Sausage-like fingers and toes
- Plantar fasciitis, which refers to pain in ball of foot
- Conjunctivitis which may commonly be referred to as pink eye
There are many types of psoriatic arthritis. The sub-type of arthritis you are diagnosed with depends on where the symptoms occur and how many joints are affected. Currently, five types of psoriatic arthritis have been identified:
- Symmetrical polyarthritis psoriatic arthritis that affects multiple joints with comparable severity on both sides of the body
- Asymmetric oligoarticular psoriatic arthritis that affects few joints on one side of the body
- Spondylitis psoriatic arthritis affecting joints in the lower back and near the spine
- Distal interphalangeal psoriatic arthritis in the joints of the fingers and toes
- Arthritis mutilans a severe form of psoriatic arthritis that causes deformation of the joints, especially in the hands and feet
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How Do You Treat Plaque Psoriasis
Doctors advise starting with the mildest treatment that might help you, depending on your type of psoriasis and how much of your body it covers.
The most frequently prescribed medications are corticosteroids, available as ointments, creams, lotions, gels, foams, sprays, and shampoos. You might apply the medicine once a day during flares, and on alternate days or weekends only when you dont have symptoms.
Corticosteroids, however, can stop working over time. If that happens you can try vitamin D, which slows the growth of skin cells, or retinoids, calcineurin inhibitors, salicylic acid, or coal tar .
Light therapy can be used alone or with other medications. Youll need repeat treatments, but you might be able to do them at home. You might even rely on sunlight, on a schedule.
In a treatment known as PUVA, you take a light-sensitizing drug called psoralem before exposure to UVA light. But there are both short-term and long-term side effects.
There are also oral drugs that suppress the immune system.
Losing weight and exercise can help as well.
If no treatment helps and your case is moderate to severe, you might try one of the newer treatments called biologics . They require an IV infusion or injection, though sometimes you can do the injection at home by yourself or with help.
Bimekizumab also treats psoriatic arthritis.
The National Psoriasis Foundation has more about psoriasis.
What Can You Do To Help Improve Psoriatic Nail Disease
- Keep your fingernails and toenails as short as possible – long or loose nails are more likely to catch and can cause more damage to the skin underneath the nail.
- Keep your nails dry.
- Protect your nails by wearing gloves when doing any manual work.
- Avoid a manicure of the base of the nail. This may cause an infection.
- Avoid false nails as they may damage the cuticle and make it difficult to apply treatments to the nail.
- Nail varnish can be used to cover up pitting. Nail varnish remover containing acetone should not be used, as it can cause damage to the nail.
- If you have painful toenail psoriasis then you should see a person who is qualified to diagnose and treat foot disorders .
Note: if you have psoriatic nail disease and develop pain or swelling in one or more of your joints or if you develop pain in your heel then you should see your doctor as soon as possible. You may be developing psoriatic arthritis. It is important that you are seen by a doctor specialising in joint diseases early. It has been shown that the sooner this condition is treated, the less likely you are to suffer permanent damage to your joints.
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Nail Psoriasis Treatment Options
Psoriasis is primarily a genetic condition. It cannot be cured or prevented. However, treatments for nail psoriasis are available to help your nails look and feel better. Always take gentle care of your nails if you have psoriasis. Vigorous attempts to remove debris from beneath your nails could cause a flare-up. If you feel self-conscious, nail polish is safe to use and can reduce the appearance of surface irregularities.
Here are the recommended treatment options for nail psoriasis.
Miscellaneous Systemic Therapies: Fumaric Acid Esters Sulfasalazine And Leflunomide
Fumaric acid esters , sulfasalazine, and leflunomide have also been reported to be effective in nail psoriasis however, based on the current knowledge, they cannot be advised for this indication. FAEs have been used for the treatment of chronic PP since 1959. The commercially available form, containing mainly dimethylfumarate, is currently a first-line systemic therapy for severe chronic PP in several European countries it is not effective in PsA. The general opinion is that it has little efficacy in nail psoriasis, but one case has been reported in which it was effective both on nail bed and nail matrix psoriasis . Side effects are frequent in patients using FAEs, such as episodes of flushing, abdominal pain, and a decrease in lymphocyte count.
Sulfasalazine is an aminosalicylate used as a traditional disease-modifying antirheumatic drug for the treatment of peripheral involvement in PsA. Sulfasalazine is metabolized by gut flora into sulfapyridine and 5-aminosalicylic acid, which act as anti-inflammatory agents. The role of sulfasalazine in cutaneous psoriatic lesions and nail psoriasis is not generally accepted. One case has been reported on the use of sulfasalazine in the treatment of psoriatic nail lesions . After 3 months, nail lesions started to recede and disappeared progressively. No other cases have been reported in literature.
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Which Areas Are The Hardest To Treat
Psoriasis mostly affects the torso, arms, and legs. However, health experts are finding that other areas are also commonly affected. These sensitive areas can be harder to treat and may cause serious physical, social, and mental health challenges. Learning about treatment options can help you find relief for your symptoms.2,3
Recent Developments In The Treatment Of Np
Overview of available therapies. In recent years, substantial progress has been made in understanding the pathogenesis of psoriatic skin and joint disease, and several highly effective therapies are now available for the treatment of moderate to severe disease. However, NP research has been far more limited, and determining an appropriate treatment course can be challenging. This leads to the undertreatment of NP, which is a significant unmet need in the management of PsD in a Dutch Psoriasis Association survey, only 16% of patients were receiving treatment for NP.
Topical therapies are often used as first-line treatment for mild NP, but efficacy is modest even when disease is limited to minimal dystrophy in 1 or 2 nails., Application of topical therapies to nails is messy, most drugs do not adequately penetrate the nail bed and nail matrix, and use of topical corticosteroids can result in nail and underlying phalanx atrophy, nail striae, telangiectasias, tachyphylaxis, and other adverse consequences associated with systemic absorption of corticosteroids.,
Available data, generally from cohort studies , indicate that intralesional injection of corticosteroids or methotrexate directly into the nail matrix can be an effective treatment for NP however, these procedures are unpopular among patients and physicians because they can be very painful and time consuming, with side effects including subungual hematomas, short-term paresthesia, and atrophy at the injection site.,,
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Management Of Nail Psoriasis
The choice of treatments depends on clinical presentation, as well as patient-related factors. Most patients have only mild nail psoriasis without signs of PsA or severe PP. These patients may profit from topical treatment, while systemic treatment is indicated in patients with severe nail psoriasis, major impact on QoL, or concomitant moderate to severe psoriatic skin lesions. Systemic therapy should also be favored if concomitant PsA is evident. The choice of treatments further depends on patient factors, including age, experienced burden of disease, accompanying diseases and therapies, individual patient preferences, and the risks of treatment.
Where Can Patients Find Support For Nail Psoriasis
Education is one of the foundations for managing this chronic and typically relapsing disorder. People with psoriasis should be familiar with the treatment options in order to make proper informed decisions about therapy. The National Psoriasis Foundation is an excellent organization that provides support to people with psoriasis.
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How To Treat Nail Psoriasis Naturally
Psoriasis of the nails is probably the most challenging form of psoriasis to treat. Many treatments have been used and documented, but conclusive results have not been achieved yet. Therefore, the first nail psoriasis treatment to consider should be non-medical/ natural approaches of caring for your nails. Here are a few things you can do:
- Make sure you nails are short. It may seem simple and unnecessary, but a very strategic way of approaching the condition. Have you nails trimmed to the skin, and file them properly.
- Avoid using sharp objects when removing debris from the inside of the nail. Sharp objects aggravate Onycholysis in addition to making things worse. If you must remove the dirt, then it is wise to soak them in lukewarm soapy water for a few minutes. This should effortlessly get rid of the debris.
- Take considerable steps to protect your ailing nails from further damage, since any form of damage can worsen the condition. If at all possible, wear gloves to safeguard your nails from dirt and any unforeseen damage.
What Nail Psoriasis Looks Like
Nail psoriasis causes changes to your fingernails and toenails
This fingernail shows 3 signs of nail psoriasis: Crumbling, roughness, and blood under the nail .
Common signs of nail psoriasis
This nail also has 3 signs of nail psoriasis: Tiny dents in the nail , white discoloration, and lifting .
Most people who have plaque psoriasis develop nail psoriasis
Discoloration , nail lifting from the finger, and a thin line of blood are common signs of nail psoriasis.
Nail psoriasis usually begins years after psoriasis first appears on the skin
This patients nail has 3 common signs of nail psoriasis: Grooves, blood beneath the nail , and lifting of the nail from the finger.
Nail psoriasis can be mild
If you have psoriasis, ridges and a thin line of blood beneath the nail can be signs of nail psoriasis.
Improvement from treatment happens slowly
Nails grow slowly, so it will take 6 months or longer to clear debris, a common sign of nail psoriasis, beneath the nail.
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When To See A Doctor
Nail psoriasis is not contagious, and treatment can reduce or help control the symptoms.
If the nails show symptoms of psoriasis or a fungal infection, see 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 they may take up to a year to clear. One reason for this is that the nail plate grows very slowly. The symptoms may also return at a later date.
With new drugs appearing on the market, more effective treatments for nail psoriasis may be on the horizon.
How To Care For And Treat Nail Psoriasis
You may know that psoriasis is a condition that affects the skin, but what about the nails? Nail psoriasis is the term for the changes in your fingernails and toenails that occur as a result of having psoriasis. Up to half of all people who have psoriasis will have nail psoriasis as well.
While its not a life-threatening condition, nail psoriasis can affect your quality of life, since it may cause you discomfort and affect your self-esteem, and it may also put you at greater risk of developing psoriatic arthritis. Although it cannot be cured, nail psoriasis can be helped with treatment.
Nail psoriasis occurs because psoriasis affects the process of nail formation. People who have nail psoriasis usually have psoriasis on other parts of their body, such as the skin and joints. Rarely does someone have only psoriasis of the nails.
Symptoms of nail psoriasis vary but may include:
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Discoloration of the nail to yellow-brown Pitting in the surface of the nails Horizontal lines across the nails White patches on the nails Thickening of the nails Nails that separate from the nail bed
Treatment Options
Your treatment will depend on the type of nail psoriasis you have and how severe it is. If you have psoriasis that affects other parts of your body, the treatments your doctor recommends to alleviate those symptoms may also help your nail psoriasis.
Other options for nail psoriasis include:
Topical treatmentsThese medications are applied to the nails:
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