Nail Psoriasis Quick Guide
Learn more about the signs of nail psoriasis, Treatment options and get tips for caring for your nails without making your nail psoriasis worse.
Betteridge, N., Boehncke, W. H., Bundy, C., Gossec, L., Gratacos, J., & Augustin, M. . Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol, 30, 576-585. doi:10.1111/jdv.13306
Jiaravuthisan, M. M., Sasseville, D., Vender, R. B., Murphy, F., & Muhn, C. Y. . Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol, 57, 1-27. doi:10.1016/j.jaad.2005.07.073
Merola, J. F., Li, T., Li, W. Q., Cho, E., & Qureshi, A. A. . Prevalence of psoriasis phenotypes among men and women in the USA. Clin Exp Dermatol, 41, 486-489. doi:10.1111/ced.12805
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.
What Are Medical Treatments For Nail Psoriasis
A doctor may recommend that a part of the nail be removed, either chemically or surgically. Chemical removal of the nail involves putting an ointment on the nails for seven days. The nail comes off by itself with no bleeding.
Even with effective treatment, an improvement in symptoms may take a long time, since eight to 12 months can be needed to generate a new fingernail.
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What You Should Know Before Starting Laser Treatment
Laser treatment for psoriasis can produce dramatic results in some people but this therapy isnt for everyone. To make sure youre a good candidate, have a complete health history and exam done before starting treatment.
Avoid laser treatments if you have:
- Lupus or scleroderma
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1. To assess the efficacy of 8 weeks of excimer laser in treating fingernail psoriasis in a randomized, blinded, right-left comparison trial. Due to slow growth rate of fingernails, final efficacy assessment will be performed at week 16.
a. To compare the mean improvement in target nail mNAPSI score of excimer laser treated hand compared to sham treated hand.
b. To assess the proportion of patients achieving NAPSI 50 and NAPSI 75 at week 16.
c. To assess the proportion of patients with no nail psoriasis at weeks 16.
d. To compare changes from baseline in physicians and patients assessment of nail psoriasis activity .
2. To assess the adverse events associated with excimer laser treatment of nail psoriasis.
a. To compare immediate and delayed symptoms in excimer treated fingers compared to sham treated fingers.
How Is Psoriatic Nail Disease Diagnosed
The diagnosis of psoriatic nail disease is usually made by the appearance of the affected nails. Sometimes scrapings from under the nail, and nail clippings, are sent to the laboratory to be tested for fungal infection of the nail, which can sometimes look like psoriatic nail disease.
Occasionally, a sample of nail is needed to confirm the diagnosis.
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How To Treat Psoriasis Nail Bed
Treatment that works throughout the body: If you have severe psoriasis and nail psoriasis, your dermatologist may prescribe medicine that can treat both your skin and nails. As with other treatment for nail psoriasis, it can take months to see results.
Learn about how long you will have to treat your psoriasis. The AADs Coronavirus Resource Center will help you find information about how you can continue to care for your skin, hair, and nails. To help care for your skin during the corona.
While you may have had an inkling that a bad breakup or a stressful work situation is the reason for an acne flare-up, there is now a shed load of science to prove it, meaning psychological treatment.
Pitting on the surface of the nail. Defects in the nail, such as ridges or crumbling nails. Yellowish color to the toenails .
Left untreated, the condition can damage joints and bones so severely that it leaves sufferers unable to walk.
Crumbling: due to weakening of the nail bed or matrix Splinter hemorrhages.
There is no cure for nail psoriasis but hopefully these treatments may help improve the appearance of your nails.
same topical and systemic therapies that are used to treat psoriasis that affects the skin. In some cases, medicines can be injected into the nail bed.
Crumbling: due to weakening of the nail bed or matrix Splinter hemorrhages.
There is no cure for nail psoriasis but hopefully these treatments may help improve the appearance of your nails.
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Pathophysiology Of Nail Psoriasis
The pathogenesis of the psoriatic nail disorder is not completely known. Nail psoriasis may be due to a combination of genetic, environmental, and immune factors. A well-known fact is that a familial aggregation of psoriasis exists. Studies have linked psoriasis with certain human leukocyte antigen subtypes . A T-cellmediated inflammatory process is being investigated as part of the pathogenesis of psoriasis.
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The Difference Between Nail Psoriasis And Nail Fungus
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Trying to figure out whether you have nail psoriasis or nail fungus may keep you on your toes. There are a lot of similarities between the two and you can actually have both conditions at the same time but they’re different from each other and require different types of treatment.
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Psoriasis is a skin disorder in which your immune system overreacts, causing inflammation in your skin cells and forming scaly or red patches called plaques. Sometimes, these plaques can be itchy or painful. You can also develop psoriatic arthritis, which causes joint pain and swelling. There’s no cure for psoriasis, but there are ways to alleviate many of its symptoms and provide relief.
Fungal infections are different: They’re curable infections that occur when a bunch of fungi come into contact with your skin and get in between your nail and nail bed. These infections spread quickly and can be contagious. Often, you tend to pick them up in warmer, moist climates. Walking barefoot in wet, high-traffic areas like locker rooms, beside pools or even in garden soil may lead to infection, especially if you have an open wound like a cut or small scrape.
Conditions With Similar Symptoms
Nail psoriasis can resemble a fungal infection, such as onychomycosis. This also causes the nails to thicken. Moreover, onychomycosis often occurs alongside nail psoriasis. This can make diagnosis difficult.
Getting a correct diagnosis is important because the treatment for a fungal infection is different from the treatment for nail psoriasis. Anyone with psoriasis and changes in their nails should make sure that their doctor is aware of their psoriasis.
Nail psoriasis does not always cause physical pain, but some people may find it unsightly, and it can cause embarrassment. Treatment can prevent it from worsening.
Treatments include:
- topical medicines, such as creams applied directly to the nails
- systemic medications, which affect the whole body
- intralesional therapies, which involve a doctor injecting medication into the nail bed
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What Are Nail Psoriasis Symptoms And Signs
Usually, people who have nail psoriasis also have skin symptoms, too. If someone has psoriasis of the nails but does not have skin symptoms, the condition may be difficult for a doctor to diagnose, since the signs of psoriasis of the nails resemble those of fungal infection of the nails. It is important to inform the doctor if there is a family history of psoriasis.
The nail unit is made up of a nail plate, nail bed, hyponychium, nail matrix, nail folds, cuticle, anchoring portion, and ends of the finger bones. See each of these structures in images 1-2.
Someone might notice the following signs with psoriatic nails:
Nail psoriasis can also occur together with fungal infections of the nail and inflammation of the skin around the edges of the nail .
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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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.
Measures To Prevent Nail Psoriasis
It is vital to take good care of your nails to prevent nail psoriasis from developing or worsening. Prevention is also important to avoid the complications associated with nail psoriasis until treatment is complete.
Heres what you can do:
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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
Prevention Of Nail Psoriasis
Good nail care is the best way to treat nail psoriasis. Try these prevention tips:
- Keep your nails trimmed short.
- Use a nail file to keep nail edges smooth.
- Wear gloves to clean and do other work with your hands.
- Moisturize your nails and cuticles every day and after they’ve been in contact with water.
- Wear comfortable shoes with enough room for your toes.
If you’re unhappy with the way your nails look, try nail varnish or artificial nails. They can also protect your nails from more damage. Some people are sensitive to the chemicals in varnish and nail adhesive. Talk to your doctor about whether these are right for you.
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For Best Results From Treatment
Treating nail psoriasis can be a challenge. It often takes time to treat. To get results, you need to treat your nails as directed and for as long as directed. Some patients need to try a few treatments to find one that works.
The right nail care can help you get the best results from treatment. Youll find out what dermatologists recommend at: 7 easy-to-follow nail care tips that can reduce nail psoriasis
ImagesImages used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol 2013 69:249.
ReferencesCrowley JJ, Weinberg JM, et al. Treatment of nail psoriasis: Best practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015 Jan 151:87-94.Dogra A, Arora AK. Nail psoriasis: The journey so far. Indian J Dermatol. 2014 Jul 59:319-33.Lin YK, Chang YC, et al. A Chinese herb, indigo naturalis, extracted in oil used topically to treat psoriatic nails: A randomized clinical trial. JAMA Dermatol. 2015 Jun 151:672-4.Manhart R, Rich P. Nail psoriasis. Clin Exp Rheumatol. 2015 Sep-Oct 33:7-13.van der Velden HMJ, Klaassen KMG, et al. Fingernail psoriasis reconsidered: A case-control study. J Am Acad Dermatol 2013 Aug 69:245-52.
All content solely developed by the American Academy of Dermatology
The American Academy of Dermatology gratefully acknowledges the support from Amgen and .
Pulsed Dye Laser For The Treatment Of Nail Psoriasis
Cutis
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- Steven R. Feldman, MD, PhD
Publish date: November 9, 2012
Dr. Feldman discusses UVB phototherapy for the treatment of psoriasis.
From the Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida.
The authors report no conflict of interest.
Correspondence: Sonal Choudhary, MD, 1475 NW 12th Ave, Ste 2175, Miami, FL 33136 .
Psoriasis can involve the skin, joints, and nails, either alone or in combination. Psoriasis of the nails can involve both the nail bed and nail matrix. The treatment of nail psoriasis largely depends on the severity of symptoms. The pulsed dye laser recently has demonstrated efficacy in treating resistant plaque-type psoriasis and has been suggested as an alternative to conventional therapies. We review 4 studies of PDL for nail psoriasis and discuss the findings in relation to treatment recommendations. Ultimately, a standardized regimen for the treatment of nail psoriasis remains elusive.
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Combination Therapy With Corticosteroids
Tacalcitol is another chemical vitamin D analog that has been investigated in a small, open study with both nail bed and nail matrix psoriasis. Patients were treated with a nail lacquer containing 8 % clobetasol-17-propionate applied at bedtime during the weekend, and with tacalcitol 0.1 % ointment under occlusion on the remaining days, for 6 months . Clinical characteristics of nail bed and nail matrix psoriasis improved markedly, and target NAPSI had improved 50 % at 3 months, and 78 % at 6 months.
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.
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What Treatments Are Available
Mild nail disease which isn’t causing discomfort does not need any treatment. If the nail disease is severe and causing problems then your doctor may refer you to see a skin specialist for advice and treatment. Unfortunately treatment of psoriatic nail disease is difficult and not always successful.
Treatments for nail psoriasis include:
- Treatments applied to the nail, which include steroids, salicylic acid, calcipotriol or tazarotene. Local treatments applied to the nail are often not very effective but are worth trying. If the nail is lifting off then strong steroid scalp application can be trickled under the nail.
- Antifungal treatment – this may be required for fungal nail infection if this is also present.
- A steroid injected into the nail – this may be effective for some types of nail psoriasis but it is painful.
- Light therapy – psoralen plus ultraviolet light A treatment is effective for some types of nail psoriasis but not for pitting of the nail.
- Removing an affected nail – this can be done by applying a special type of ointment and then covering the nail for seven days. Otherwise the nail can be surgically removed using local anaesthetic.
