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.
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.
How Is Toenail Psoriasis Treated
Unfortunately, not many good treatment options exist for toenail psoriasis. Conservative treatment usually begins with topical corticosteroid creams or ointments, or non-steroidal alternatives such as Tazorac and Dovonex.
The drawback to these creams and ointments is that they may not penetrate the nail plate adequately. Also, long-term steroid use can cause the skin and nails to thinwhich takes months to grow out.
Another treatment option is phototherapy. This involves treating the nails with topical or systemic psoralen compounds, which cause the nail to respond to ultraviolet light.
According to some experts, the best treatment involves intralesional steroid injections. This means injecting cortisone into the base of the nail and into the nail folds alongside it. This treatment can be effective, and when done properly it is not as painful as it sounds.
Proper care of your feet and nails is vitally important if you have psoriasis. Avoid getting pedicures, as nail salon personnel often treat the nails roughly, and many of them trim cuticles, , which allows bacteria to enter the nail , and is especially bad for persons affected with toenail psoriasis.
Keep your toenails short to avoid injury, and try to keep the nail folds clean and dry. Above all, one of the best treatments for psoriatic nails is control of your overall psoriasis.
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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.
Salt Bath To Treat Nail Psoriasis
Soaking affected fingers in salt bath is an effective way to get relief from this condition. For this take warm water in a large bowl. Add required quantity of dead sea salt or Epsom salt or Himalayan pink salt or combination of all three salts to this warm water. Soak fingers or toes in this salt mixed water for half an hour. This softens and cleanse nails and its surrounding area. It also disinfects the affected part. Pat dry nails and massage ayurvedic cream for psoriasis or ayurvedic oil for psoriasis. Salts also help creams or oils to penetrate deep. You can trim nails after this salt bath.
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How To Cure Nail Psoriasis
How to cure nail psoriasis? This question is quite difficult to be answered as unfortunately, you may not be able to find a complete cure to eliminate nail psoriasis. However, you can still use some treatment for nail psoriasis which can help you improving the appearance of the affected nail area. There are various ways to treat nail psoriasis including surgical and medical and some of them are mentioned below
Epidemiology Of Nail Psoriasis
Psoriatic nail disease occurs in 10-55% of all patients with psoriasis, and approximately 7 million people in the United States have psoriasis . Less than 5% of psoriatic nail disease cases occur in patients without other cutaneous findings of psoriasis. About 10-20% of people with psoriasis also have psoriatic arthritis, and nail changes are seen in 53-86% of patients with psoriatic arthritis.
Psoriasis tends to run in families. In Farber’s questionnaire study of 2100 patients, 36% of patients reported the presence of psoriasis in at least 1 relative. Among siblings, 8% are affected if neither parent has psoriasis. This percentage increases to 16-25% if 1 parent or sibling has the disease, and it reaches up to 75% if both parents are affected. If 1 twin has psoriasis, the other twin is at an increased risk of having psoriasis .
In Scandinavia, the prevalence rate of nail psoriasis for adults with psoriasis approaches 5%. The prevalence increases with the age of the population studied.
Psoriatic nail disease is not associated with mortality. In severe cases, patients may have functional and psychosocial impairments.
Males and females are affected equally by nail psoriasis, and the prevalence of nail psoriasis increases with the age of the population studied.
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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.
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.
Calcipotriol: In one study, researchers found this to be as effective as a potent corticosteroid at treating the buildup beneath the nail.
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:
Therapy Radiation Therapy And Laser Therapy
Although phototherapy with narrow-band UVB and photochemotherapy with UVA, in addition to oral psoralen , have been successfully used in psoriasis, there is not enough evidence to support their beneficial effects in nail psoriasis. Several small studies have shown that PUVA can help psoriatic nails with variable results. The pitting and onycholysis have demonstrated poor response to PUVA treatment . A recent study on the penetration of UV lights in normal human cadaveric fingernail plate showed that the nail plate completely blocks UVB light but only a minimal amount of UVA penetrates the nail . This may explain the limited effect of PUVA in nail psoriasis.
Superficial radiotherapy, electron beam therapy, and Grenz rays have been infrequently used in the treatment of nail psoriasis with temporary benefits. The possibility of localized fibrosis and carcinogenesis should be considered in radiation therapy . Soft X-rays have been used for very thick psoriatic nails in one case, in fractionated doses of 1.5Gy for a total of 13.5Gy at 1- and 2-week intervals. The nail plates became normal after 12 months of therapy .
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Traditional Oral Systemic Therapies18
Traditional oral systemic therapies for nail psoriasis.
Although traditional systemic therapies have not been rigorously tested, oral cyclosporine, an immunosuppressant drug that interferes with activity and growth of T cells, has modest efficacy in nail psoriasis,,,,. Oral methotrexate , an antimetabolite and antifolate drug commonly used to treat psoriasis and inflammatory arthritis, has been tested rigorously, but is unlikely to result in significant improvement in psoriatic nail disease,,,,. Briakinumab was superior to MTX in 1 study. Acitretin, a second-generation retinoid and a metabolite of etretinate, had modest efficacy at doses of 0.20.3 mg/kg/day for 6 months,,,. Leflunomide, an oral pyrimidine synthesis inhibitor, also had modest efficacy in psoriatic nail dystrophy when dosed at 100 mg/day for 3 days, then 20 mg/day for 24 weeks.
Tumor necrosis factor- plays a key role in the pathogenesis of psoriasis and PsA, and can interrupt TNF signaling, thereby leading to improvements in nail dystrophy. In several controlled studies, adalimumab ,,,,,,,,,,, certolizumab pegol, etanercept,,,,,,, golimumab,, and infliximab,,,,,,,,,,, were highly efficacious in treating psoriatic nail disease. Larger studies are necessary to determine comparative effectiveness of these agents,,,,.
Combination therapies for nail psoriasis.
Changes In Nail Shape Or Thickness
In addition to pitting, you might notice other changes in the texture of your nails. Psoriasis can cause lines called Beaus lines to form across your nails.
Weakness of the structures that support nails can cause your nails to crumble. Nails can also become thicker due to a fungal infection called onychomycosis, which is common in people with psoriasis.
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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.
Recommendations For The Definition Evaluation And Treatment Of Nail Psoriasis In Adult Patients With No Or Mild Skin Psoriasis: A Dermatologist And Nail Expert Group Consensus
- University of Mississippi Medical Center, Jackson, MississippiUniversity of Alabama, Birmingham, Alabama
- Department of Dermatology, Inselspital, University Bern, Bern, SwitzerlandCentro de Dermatología, Instituto CUF, Porto, Portugal
- Natalia RompotiCorrespondenceCorrespondence to: Natalia Rompoti, MD, University Hospital of Venereal and Skin Diseases A. Sygros, 5, Ionos Dragoumi, 161 21 Athens, Greece.
- Adam I. RubinAffiliationsDepartment of Dermatology, Hospital of the University of Pennsylvania, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Martin ZaiacAffiliationsGreater Miami Skin and Laser Center, Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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Dab Some Tea Tree Oil
Tea tree essential oil has antibacterial, antifungal, and antiseptic properties that can fight fungal and bacterial infections of the nails. This essential oil is also rich in terpinen-4-ol, which is an anti-inflammatory agent and helps reduce the pain.
How to use:
How To Prevent Thick Toenails
You can prevent thick toenails by the following measures,
Keep your feet and hands clean by following good hygiene practices. Dry them immediately after a wash
- Walking barefoot at home to let your feet breathe
- Avoid walking barefoot in public places
- Disinfect your nail trimming tool kit regularly
- Avoid constant exposure to wet areas
- Wear flip-flops in locker or sauna rooms
- Use a foot powder to keep them dry and clean
- Moisture your feet regularly using a thick moisturizer to soften your nails
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Treatment Of Nail Psoriasis In Children
Despite the common onset of psoriasis in the childhood, validated clinical data on the epidemiology and the treatment of pediatric nail psoriasis is scant. In a recent multicenter study conducted in US, 39.2% of 181 children with psoriasis were found to have nail involvement . Similar results were reported from Kuwait , although in more than half of the cases the changes, pitting being the most common, were so subtle that the children were not aware of them . Nail psoriasis was found to be more common in boys, probably related to koebnerization . There are no studies on the efficacy and safety of various treatments for nail psoriasis in children. The absence of clinical data corresponds with a lack of licensure for the pediatric use of many available treatments .
Data was available for the treatment of nail psoriasis from an epidemiologic study of pediatric psoriasis from Turkey. Thirteen children with nail psoriasis were treated with potent topical steroid ointments for onycholysis and nail bed hyperkeratosis however, the results were unsatisfactory . In a pilot study of 4 children to determine the efficacy of intralesional triamcinolone acetonide in the treatment of nail pitting in children, following a single dose, the degree of pitting was reduced by a mean of 15% in the second month and 42% in the fourth month .
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Nail Infection Needs Treatment Too
A nail infection can develop if you have nail psoriasis. Because a nail infection can look a lot like nail psoriasis, its important to find out if you have an infection. Testing, which usually consists of scraping the nail, can find an infection. If you have a nail infection, treatment can get rid of it.
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Treat Your Nails To Some Tlc
Whatever treatment you receive, its important to avoid irritating or injuring your nails. Irritation and injury can drive the inflammation that drives psoriasis, explains Dr. Kassouf.
Avoid picking at your nails and manipulating them, and steer clear of harsh chemicals, such as those found in acetone and non-acetone nail polish removers.
Follow these nail-care tips at home, too:
- Keep your fingernails and toenails trimmed short and filed evenly .
- If you have damaged nails, wear gloves when cleaning or doing work around the house.
- Always wear socks with shoes and make sure your shoes fit properly, so as not to irritate toenails further.
The progress for your nails may be slow. It can take three to six months before you see any improvement, Dr. Kassouf says. But most people do improve with the therapies available today.
Pick The Right Polish And Polish Remover
Polish can go a long way toward improving the appearance of nails, as well as provide a level of protection. A strengthening or ridge-filling base coat can help shore up weak or brittle nails. But some ingredients found in nail lacquer for instance, formaldehyde and toluene can cause contact dermatitis in some people with psoriasis, who have sensitive skin. To sidestep them, consider using 5-free nail polish, which refers to products that dont contain these types of ingredients. Dr. Sutera likes Dr.s Remedy Enriched Nail Care products.
When it comes to polish removal, opt for a product that doesnt contain acetone, a harsh solvent. Non-acetone removers are less drying and gentler on sensitive skin.
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Data Abstraction And Quality Assessment
Two independent reviewers abstracted data using a predefined data extraction form. The following information was extracted from each study: author, year of publication, design of study, blind time period, patient type, details of the interventions, sample size, baseline nail psoriasis involvement, and the improvement at each visit till the end of study. We independently assessed the quality of each included study in accordance with the Cochrane handbook of systematic reviews of interventions 5.2, which covers the following: random sequence generation allocation concealment blinding of participants and treatment providers blinding of outcome assessors , incomplete outcome data , selective reporting , and other biases. Disagreements over any risk of bias in particular studies were resolved by a third reviewer.
How Topical Medicine And Injections Work To Fight Nail Psoriasis
If your psoriasis is confined to the nail bed , topical steroids, vitamin D3 analogue ointments and retinoid creams or gels can be effective.
But psoriasis typically goes deeper, affecting the nail matrix . While topical treatments dont penetrate the matrix of the nail, steroids can be safely injected around the nail with good efficacy.
These injections are both safe and effective in reducing the pitting, hardening, ridging and discoloration, as well as nail separation caused by nail psoriasis, says Dr. Kassouf.
Dermatologists usually administer injections monthly, then reassess the nails to see if further treatments or dosage changes are needed.
If you cant tolerate or dont respond to injections, oral medications are occasionally used especially when you have psoriasis-related arthritis or significant skin changes.
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