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Psoriatic Nails
The Ultimate Guide
Psoriatic nails refer to changes in the fingernails or toenails associated with psoriasis, a chronic autoimmune condition that primarily affects the skin but can also impact the nails.
What are Psoriatic Nails?
Psoriatic nails refer to changes in the fingernails or toenails associated with psoriasis, a chronic autoimmune condition that primarily affects the skin but can also impact the nails. Nail psoriasis is common among people with psoriasis, with up to 50% of individuals with the skin condition experiencing nail involvement at some point. In those with psoriatic arthritis, the likelihood of nail changes is even higher. Psoriatic nails can be a source of discomfort and can significantly impact the appearance and function of the nails.
Symptoms and Causes
Psoriatic nails can present a variety of symptoms, often affecting both the fingernails and toenails:
Pitting:
One of the most common symptoms, pitting, involves the formation of small depressions or pits on the surface of the nail. These pits are caused by the loss of cells from the nail's surface.
Discolouration:
The nails may develop a yellow-brown discolouration, often referred to as "oil drop" or "salmon patch" discolouration, which is a hallmark of nail psoriasis.
Onycholysis:
This is the separation of the nail from the nail bed, which can cause a gap where dirt and debris can accumulate, leading to further complications like infection.
Thickening and Crumbling:
The nails may become thickened and start to crumble, particularly at the edges. This can make the nails more difficult to manage and more prone to damage.
Subungual Hyperkeratosis:
This involves the build-up of a chalky, crumbly substance under the nail, which can cause the nail to lift away from the nail bed.
Redness and Inflammation:
The skin around the nails may become inflamed, red, and swollen, particularly in cases of psoriatic arthritis.
Causes:
Psoriatic nails are caused by the same autoimmune process that drives psoriasis, where the immune system mistakenly attacks healthy skin cells. This leads to an overproduction of skin cells, including those in the nails, resulting in the characteristic symptoms. Nail psoriasis occurs when the disease affects the nail matrix (the area under the cuticle where new nail cells are produced) or the nail bed (the skin underneath the nail). Genetic factors, environmental triggers, and stress can all contribute to the development or worsening of psoriatic nail changes.
Management and treatment
Managing psoriatic nails can be challenging, but with the right approach, symptoms can be alleviated, and the appearance of the nails can be improved. Treatment focuses on managing the underlying psoriasis, protecting the nails, and preventing complications.
Topical Treatments:
Corticosteroids:
Topical corticosteroid creams or ointments can be applied to the affected nails to reduce inflammation and slow down the overproduction of skin cells.
Vitamin D Analogues:
These are often used in conjunction with corticosteroids to help normalise the growth of skin cells and improve nail appearance.
Calcipotriol:
Another topical treatment, calcipotriol, is a synthetic form of vitamin D that can help slow the growth of skin cells under the nails.
Systemic Treatments:
Oral Medications:
For severe cases, systemic treatments such as oral medications (e.g., methotrexate, cyclosporine) may be prescribed to manage the overall psoriasis and its impact on the nails.
Biologic Therapies:
Biologics, which target specific parts of the immune system, can be particularly effective for individuals with both nail and skin psoriasis or psoriatic arthritis.
Nail Care:
Regular Trimming:
Keeping the nails trimmed and filed can help reduce the risk of injury and prevent them from catching on objects. It’s important to avoid aggressive trimming or cutting the nails too short.
Moisturising:
Applying moisturiser to the nails and cuticles can help prevent dryness and cracking. Specialised nail care products designed for psoriatic nails may also be beneficial.
Protection:
Wearing gloves when performing tasks that could damage the nails and avoiding harsh chemicals can protect the nails from further trauma.
Medical Interventions:
Intralesional Injections:
In some cases, a healthcare professional may administer corticosteroid injections directly into the nail matrix to reduce severe inflammation and improve symptoms.
Phototherapy:
Light therapy, or phototherapy, can be used to treat nail psoriasis, particularly in conjunction with systemic treatments.
Psoriatic nails can be a challenging aspect of living with psoriasis, but with proper management and care, symptoms can be controlled, and the appearance of the nails can be improved. Early diagnosis and treatment are crucial to preventing severe damage and maintaining nail health. Individuals with psoriatic nails should work closely with their healthcare provider to develop a treatment plan tailored to their specific needs, ensuring the best possible outcomes for both their nails and overall health.