What Is The White Hard Stuff Under My Toenails
Keratin is a protein that promotes the development of the skin and nails. Nail psoriasis sometimes causes too much keratin to grow under the nail. This overgrowth is called subungual hyperkeratosis. People with hyperkeratosis may notice a white, chalky substance under the nail.
Trim Nails With A Clipper Or Scissors
These tools provide a cleaner, quicker cut than a file. They also eliminate the back-and-forth motion of filing, which can weaken and traumatize nails. Clip toenails straight across to avoid ingrown toenails trim fingernails straight across, then slightly round the corners while filing nails in one direction. To soften nails and make them easier to cut, soak them in warm water first for five to 10 minutes.
Preventive Measures To Reduce The Frequency Of Psoriasis Attacks
There is no known way to prevent psoriasis. However, it is possible to reduce the frequency and intensity of attacks. In addition to careful monitoring of the prescribed treatment, it is possible to observe what triggers the onset of symptoms.
This process takes time and patience. Here are some general tips:
- During long exposure to the sun, it is advisable to use an effective sunscreen.
- Alcohol consumption must be greatly diminished or eliminated altogether.
- The severity of psoriasis is often related to the number of cigarettes smoked. Try to reduce tobacco or stop smoking.
- Some sufferers have their disease diminish considerably after losing a little weight. Consider changing lifestyle habits accordingly if necessary.
- It is recognized that stress plays a role in the onset or exacerbation of psoriasis attacks. Find solutions for a better stress management.
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Can You Use Nail Polish With Nail Psoriasis
Nail polish and gentle nail buffing are okay and a great way to hide dents that can develop when you have nail psoriasis. Artificial nails, however, can increase the risk of your nails separating from your fingersa common problem in nail psoriasis.
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
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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Leave Your Cuticles Alone Unless Youre Removing A Hangnail
Pushing back or cutting cuticles or dissolving them with a cuticle remover can injure skin and set off a psoriasis flare. Another dont: cleaning debris with a sharp object or nail brush. Probing underneath the nails can cause puncture wounds and can encourage detachment of the nail, says Dr. Sutera.
Soaking the affected nails in soapy warm water may be sufficient to remove the debris.
Keep Your Nails Clean And Dry As Much As You Can
Moisture and warmth can promote bacterial and fungal growth, Patel points out, noting that thick, uneven nails with cracks and holes , is a perfect breeding ground. Using Vicks VapoRub on your nails at night helps decrease microbe growth, so does soaking your nails in Listerine Original Antiseptic the active ingredients help kill microbes and prevent infections.
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Be Extra Gentle With Your Nails
Since nail psoriasis is often associated with general brittleness, Skotnicki says to be extra gentle with your nails. And this goes beyond not picking at them. She also recommends shielding them from harsh environments by wearing cotton or rubber gloves when washing the dishes, gardening, or cleaning the house.
Grace Cary / Getty Images
Vitamin E oil and fish oils have been shown to help with inflammation of the nail beds, and can help with the cuticles and growth of nail with nail psoriasis, Patel says. Our favorite vitamin E-infused cuticle product is none other than Olive & Junes Cuticle Serum .
Symptoms Of Psoriatic Nail Disease
In addition to the symptoms that you may experience because of skin psoriasis, you might notice one or more of the following changes to your nails:
Oil Drop / Salmon Patch A yellow-red, translucent nail discoloration that resembles a drop of blood or oil beneath them. Beau Lines Horizontal lines across the nails. Nail Matrix Pits in the nails. Leukonychia White patches appearing on the nails. Subungal Hyperkeratosis Thickening of the skin underneath the nails. Onycholysis Loosening of the nails from the skin which can sometimes lead to infections. Plate Crumbling The weakened nails begin to crumble. Splinter Hemorrhaging Black lines appear in the nails, running from the tips to the cuticles. Caused by capillaries at the tips of the fingers bleeding between the nails and the skin. Spotted Lunula Redness in the normally pale arch at the bottom of the nails.
If you experience some or all of these symptoms, it is easy to visit your doctor and get a diagnosis to confirm whether or not you have nail psoriasis. It is important to treat your condition before it gets too bad, as neglect may end in infections or painful inflammation.
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Your Nails May Change Over Time
It’s normal for nails to:
- become thicker or break more easily as you get older
- become harder, softer or more brittle during pregnancy
- change colour, become loose and eventually fall off after an injury
Fingernails that fall off after an injury should grow back within 6 months. Toenails can take up to 18 months.
Grenz Ray Climatotherapy Visible Light Goeckerman And Pulsed
Evidence is insufficient to recommend grenz ray therapy for the treatment of psoriasis.
Sufficient evidence exists to recommend climatotherapy for the treatment of psoriasis.
Evidence is insufficient to recommend the use of visible light as a more effective treatment for psoriasis, except in nail psoriasis.
Sufficient evidence exists to recommend Goeckerman therapy for the treatment of psoriasis.
Pulsed-dye laser can be considered for nail psoriasis.
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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.
What Is Nail Psoriasis
Etymologically, psoriasis comes from the Greek psora, which means itching. The dead cells that are in the epidermis, which is the outer layer of the skin, are replaced by new cells. This process takes place approximately every 30 days.
However, when this renewal accelerates more than the average, then what is called psoriasis occurs. This disease causes redness on the skin or scales. These usually cause pain and itching, which can often affect the nails.
Psoriasis of the nails is defined by various abnormalities that occur on the nails of the hands and feet. Most of the time, there are small depressions that look like thimble holes, detachments or crumbling, discoloration, thickening or streaking on the nails.
On the other hand, psoriasis lesions on the nails are normally more common on the hands than on the feet. However, very often, these are the only signs of psoriasis in a person affected by this disease.
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How Can Nail Psoriasis Be Treated
Psoriasisis a condition that is unique to each person who has it, and so finding atreatment or combination of treatments that work can be a process of trial anderror. Due to how often we use our hands and feet, and the fact that nails growvery slowly, nail psoriasis can be quite difficult to treat.
Nailpsoriasis is mostly treated with topical treatment.Steroid-based treatments are likely to be offered and can be useful, but arenot suitable for long-term use. A moderately potent steroid tape isavailable on prescription and often used for nail psoriasis, as it can be cutto size and wrapped around the nail.
VitaminD-based treatments can also be useful in nail psoriasis. The treatment can beapplied to the affected area, and the fingers then wrapped or covered to helpit to absorb effectively. This should not be done with a steroid treatment. Similarly,topical retinoids applied around and under the nails atnight may be helpful for nail psoriasis. Occasionally, if a fungal infection isalso present, antifungal cream may also be prescribed.
Ultravioletlight therapy, systemic or biologic treatments are not likely to be prescribedfor nail psoriasis alone, but may improve the nails when being used to treatthe rest of a persons psoriasis. However, any nail improvement may lag behindthe rest of the skin for a few months.
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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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 .
Narrowband Ultraviolet B Phototherapy
For adults with generalized plaque psoriasis, the recommended NB-UVB phototherapy starting dose should be based on the minimal erythema dose or it should be determined based on a fixed-dose or skin-phototype protocol.
For adults with generalized plaque psoriasis, a treatment phase of thrice-weekly dosing of NB-UVB phototherapy is recommended.
For adults with psoriasis, treatment with short-term psoralen plus ultraviolet A monotherapy is more effective than NB-UVB.
Owing to its increased safety, higher convenience, and lower cost, NB-UVB is preferred over PUVA monotherapy for psoriasis in adults, even though it is less effective.
In adults with generalized plaque psoriasis, NB-UVB is recommended over broadband ultraviolet B monotherapy.
Treatment with NB-UVB monotherapy is recommended for guttate psoriasis patients, regardless of their age.
For appropriate patients with generalized plaque psoriasis, home-based NB-UVB phototherapy is recommended as an alternative to in-office NB-UVB phototherapy.
Treatment with NB-UVB phototherapy is recommended for pregnant patients who have guttate psoriasis or generalized plaque psoriasis.
As a measure to possibly improve efficacy, NB-UVB phototherapy can be safely augmented with concomitant topical therapy using retinoids, vitamin D analogues, and corticosteroids.
Oral retinoids can be combined with NB-UVB phototherapy in appropriate patients with generalized plaque psoriasis if they have not responded adequately to monotherapy.
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Consider Using A Finger Condom
Sometimes nail psoriasis only pertains to one nail. If thats your case, Patel recommends using a finger condomespecially if youve been prescribed a topical steroid to help treat it. While some stores sell finger covers, Patel says that you can easily create one by cutting the finger off a vinyl glove. That way youll get five covers per glove, which is often more cost-effective. Just keep in mind that with these DIY covers youll need something to secure them. Luckily, a bandage or medical tape works well.
Comparative Studies With Systemic Therapies
The efficacy of biologics has not only been a matter of research but differences in the occurrence of adverse events have also been investigated. A prospective, randomized, open-label study compared the incidence of onychomycosis in 315 patients with nail psoriasis treated with infliximab, etanercept, and adalimumab, and a statistically positive association between fungal infections and the use of infliximab was shown . At the end of week 24, 33 % of patients receiving infliximab had a positive fungal culture. In patients receiving etanercept and adalimumab, and controls, this percentage was 15.5, 13.3, and 13.9 %, respectively. On the other hand, NAPSI improved more in infliximab-treated patients than in patients receiving etanercept and adalimumab .
The preliminary conclusions that can be drawn from these studies are that conventional therapies are less powerful and are slower-acting treatments for nail psoriasis than biologics, possibly with the exception of cyclosporine. No single biologic appears to be superior above another biologic. Evidence suggests that infliximab may act faster, but after 1 year of treatment these potential differences have vanished. On the other hand, the use of infliximab may result in higher percentages of onychomycosis.
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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.
The Advent Of New Treatment Options: Biologic Therapy
Overall, the conventional treatment for nail psoriasis appears to be unsatisfactory, tedious, and inconvenient. Most of the treatment options achieve only a moderate efficacy, complete clearance is infrequent and efficacy of conventional therapy decreases with time. This clinical challenge faced by many dermatologists has recently been addressed with the introduction of the biological response modifiers. These agents have demonstrated efficacy in both the skin and nail components of psoriasis.
The best studied biologic agent is infliximab. The best evidence comes from the EXPRESS trial which was a phase-3 double-blinded, placebo-controlled trial . A total of 378 patients with moderate to severe plaque type psoriasis with nail involvement were randomly assigned in a ratio of 4:1 to receive infliximab 5 mg/kg at weeks 0, 2, 6, and every 8 weeks till week 46. Placebo was given at 0, 2, 6, 14, 22 and crossing over to infliximab occurred at week 24. This study showed that infliximab resulted in significant improvement in nail psoriasis as early as week 10 and at week 50 full clearance was evident in 45% of patients.
In a study done by van den Bosch et al., 40 mg of adalimumab every other week reduced the mean NAPSI score by 65% after 20 weeks .
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How To Get Rid Of Nail Psoriasis Effective Treatmens & Information
Also referred to as psoriatic nail disease, nail psoriasis is a common affliction that often accompanies skin psoriasis. Around 2 to 3 percent of the population is estimated to suffer from the skin variety of this condition, and approximately 50 percent of those end up having to deal with the nail version of it as well.
If you suffer from either condition, you know that it can often be a difficult social problem. Not only must you deal with the general problems that the disease brings, but also the misconceptions that people have about it. People may believe that youre contagious or, worse yet, assume that you have some other, dangerous disease.
In order to get away from these problems, it is important to know about nail psoriasis and how you may be able to deal with it to make your life easier.