INFOGRAPHICPSORIASIS

What Nail Psoriasis Looks Like—and Tips to Manage It

August 04, 2023
More than 8 million Americans are living with psoriasis, an immune-mediated disease that affects the skin. It can appear anywhere on the body, including your ears, eyelids, lips, and even the nails on your hands and feet. How Common Is Nail Psoriasis? 50% of people living with psoriasis have nail involvement. 90% of people living with psoriasis will experience nail psoriasis at some point or another. And up to 90% of people living with psoriatic arthritis notice nail changes, as well. Symptoms of Nail Psoriasis Psoriasis typically presents as raised, scaly, silvery patches of skin. But it appears differently on the nails. Symptoms of nail psoriasis: Pitting Crumbling Thickening Separation from the nail bed Discoloration or “oil droplets” Changes in shape or size Buildup or blood under the nail Diagnosing Nail Psoriasis Nail symptoms may be one of the first clues leading to a diagnosis of psoriasis. However, sometimes nail psoriasis doesn’t show up until years after skin symptoms begin. It’s more common in the fingernails than in the toenails. It typically affects several nails at once. Nail involvement can also be a sign of psoriatic arthritis, a joint condition that affects around 30% of people who have psoriasis. (Nail psoriasis can occur before or after joint pain begins.) Nail psoriasis is commonly misdiagnosed as: Onychomycosis (nail fungus) Anemia Thyroid issues Deficiencies in biotin, calcium, protein, vitamin A, or zinc If you notice nail changes, see your dermatologist for diagnosis and treatment. Consider also meeting with a specialist known as rheumatologist to evaluate for psoriatic arthritis. Nail Psoriasis Treatment Options Many treatments for psoriasis skin lesions also target nail involvement. These can include: Phototherapy Retinoids Immunosuppressive drugs, like cyclosporine Phosphodiesterase inhibitors, like apremilast Traditional systemic drugs, like methotrexate Newer, targeted systemic drugs, like biologics These treatments are used primarily for nail psoriasis: Corticosteroids (topicals or injections) Calcipotriene or calcitriol Topical retinoids like tretinoin or tazarotene Laser therapy Treating nail psoriasis can be tricky and take time because nails tend to grow slowly. On average for most people, it can take up to 6 months to grow out fingernails and up to 12 months to grow out toenails. Work with your doctor to find the right treatment (or combination of treatments) for you. Lifestyle Tips Nail psoriasis-related pain and tenderness can affect daily activities. These tips may help. Keep Nails Short Clip them regularly to prevent separation from the nail bed and to avoid buildup. Don’t Bite Them Biting your nails can lead to nail infection and skin injury, which may worsen psoriasis. Be Careful at the Salon A typical manicure involves pushing back or cutting the cuticles and removing buildup underneath the nail—both of which could lead to an infection and worsen symptoms. Applying artificial nails can also lead to separation. Consider bringing your own tools to the salon to reduce the risk of contamination, and tell your nail technician how to be extra careful. Or care for your nails gently at home instead. Wear Gloves From washing dishes to gardening, wearing gloves when working with your hands can help limit the risk of infection and prevent unnecessary irritation and moisture that may worsen nail symptoms. Wash Your Hands Keeping your nails clean (and dry) may help prevent nail infections, like green nails or onychomycosis, that can develop in moist environments. Moisturize Regularly Apply an emollient such as petroleum jelly after washing your hands to hydrate the nails and surrounding skin. Choose Proper Footwear Shoes with the right fit should not cause friction on your toes. Always pair your shoes with clean, dry socks. Stick with Treatment Be sure to follow your treatment regimen as prescribed for best results, and check in with your dermatologist regularly to monitor how well it’s working. Sources: American Academy of Dermatology Association. 7 Nail-Care Tips That Can Reduce Nail Psoriasis. American Academy of Dermatology Association. Psoriasis: Signs and Symptoms. American Academy of Dermatology Association. What Is Nail Psoriasis, and How Can I Treat It? National Psoriasis Foundation. (June 2022) About Psoriasis. National Psoriasis Foundation. (June 2022) About Psoriatic Arthritis. National Psoriasis Foundation. (May 2022) Early Clues to PsA. National Psoriasis Foundation. (September 2020) Hands, Feet & Nails. National Psoriasis Foundation. (October 2020) Psoriasis Statistics. National Psoriasis Foundation. (March 2020) What Your Nails Can Tell Your Doctor About PsA. Zargari O, et al. (2018) Nail Involvement in Patients with Psoriatic Arthritis in Northern Iran. Autoimmune Diseases.