Nail Psoriasis – Causes, Symptoms and Treatments

Psoriasis is a skin disease that is caused due to overactive immune response. It is a condition that normally affects the skin. Since nails are made of skin cells, the effect of this skin disease is also visible in the nails. Such a condition is called Nail Psoriasis. 

What is Nail Psoriasis?

Nail Psoriasis is a form of Psoriasis that affects the fingernails and toenails. Like other types of Psoriasis, Nail Psoriasis is also caused by the over-production of skin cells due to the body’s immune response. 

Nail Psoriasis changes the appearance of your fingernails and toenails altogether. It makes your nails get thicker, develop holes, change colour and feel tender. 

Nail Psoriasis is not a separate skin condition. If you are affected with Psoriasis of any kind, its symptoms will spread to different parts of your body. Mostly, people with Plaque Psoriasis develop Nail Psoriasis as well. 

In this blog, we delve into the details of what causes Nail Psoriasis, what are its symptoms, its treatments and much more. 

Nail Fungus vs Nail Psoriasis

Before we go any further, let’s clear up the common confusion between Nail Psoriasis and Nail Fungus. Because of the fact that both the conditions affect the nails, for many, it is hard to differentiate between these two. 

Although some of the symptoms may look similar, there are fundamental differences between Nail Psoriasis and Nail Fungus. 

Nail Psoriasis	Nail Fungus
It is a skin disease caused due to one’s immune response.	It is a skin condition caused due to fungal infection.
The immune system triggers the rapid production of skin cells that leads to Nail Psoriasis.	It is caused by fungal infections that one may pick up probably from moist and warm spots, where the fungi thrive.
Nail Psoriasis is not a contagious skin disease.	Nail Fungus is contagious as it spreads from person to person.
It affects both fingernails as well as toenails.	It mostly affects toenails as toes are more susceptible to infections.
It does not cause any dark spots on the nails.	It often causes dark spots combined with other symptoms.
It often leads to the development of pits or even tiny holes on the nails.	It doesn’t cause any pits but changes the nail shape over time.

It is essential to be aware of these distinctions between the two skin conditions. It prevents people from misjudging Nail Fungus as Nail Psoriasis and keeps them from spreading it to others.

Moreover, there is a possibility that people with Nail Psoriasis also contract Nail Fungus at the same time. Hence early medical intervention is crucial. 

What causes Nail Psoriasis?

The factor that is responsible for Nail Psoriasis is the same one that causes other forms of Psoriasis, which is the immune response. In other words, the immune system mistakenly assaults the skin cells by presuming them as harmful ones. 

This triggers the rapid production of cells known as keratinocytes in the skin and adjacent tissues. This leads to the formation of plaques on the skin and extends to fingernails and toenails as well. 

This excessive production of keratinocytes changes the appearance of the nails, thickens them and leads to discolouration. 

Having known all this, studies are yet to unravel the exact cause that makes the immune system attack the skin cells. 

What are the symptoms of Nail Psoriasis?

If you happen to develop Nail Psoriasis, you may experience one or some of the following symptoms:

Nail pitting

Have you ever seen tiny pits or holes on nails? Well, it is one of the most common symptoms of Nail Psoriasis. However, nail pitting is not only limited to Nail Psoriasis but can also be a sign of Eczema or Joint inflammation. 

It occurs because Nail Psoriasis makes your nail plates lose some cells. It may sound contradictory because Psoriasis is associated with the rapid production of skin cells. 

But under some circumstances, due to disharmony in the production and arrangement of skin cells, your nail plate may tend to lose some cells. This leads to the formation of pits on your nail plate. 

From person to person, the number of pits varies. Some develop only one pit on each finger and toenail, while others develop multiple pits. 

Blood spots

The layer that lies underneath your nail is called the nail bed. When affected by Nail Psoriasis, the blood vessels (capillaries) that lie along the nail bed get injured, and as a result, some of them burst open. 

This causes small blood spots on the nail bed that can be visible through your nail plate. It often looks like splinters; hence it is also called splinter hemorrhage. 

Discolouration

Changing nail colour is another potential symptom of Nail Psoriasis. Many people with this skin condition may experience yellow-red patches on the nail plate.

It is colloquially called oil-drop spot because it looks like a drop of oil has spilled on the nail bed. 

In some severe cases, you may experience a half-moon-shaped spot at the bottom of your nail, which is called the lunula. It forms as a result of dilated blood vessels. 

In some other cases, your fingernails and toenails may also turn a yellow-brownish colour. But in none of the cases will you develop dark spots on the nails as it is the symptom of fungal infection in nails.

Nail separation

If you happen to develop Nail Psoriasis, your nail plate will slowly start separating from the underneath nail bed. Hence a gap will form in between. 

Over time, the gap between the nails and the nail bed will enlarge and eventually in most cases, the nail will fall off. 

This condition is called onycholysis. If you experience such a condition, make sure to regularly clean the fingertips as nails as it may increase the risk of bacterial infection. 

Thickening and thinning

Nail Psoriasis can weaken the structures that hold the nails, thus making the nails crumble. It results in weakened nails and occurs to both fingernails and toenails.

In some cases, Nail Psoriasis tends to thicken the nail structures. Nail Psoriasis doesn’t have to be the sole responsibility for this—fungal infections also play a major role here. 

We have already seen that both Nail Psoriasis and Nail Fungus can affect a person at the same time. This condition is called onychomycosis.

Debris build-up

Apart from dis-figuration, your nails can also become thicker because of the build-up of chalky substances underneath your nails. This condition is called subungual hyperkeratosis.

Oftentimes, fungal infections can also be responsible for the accumulation of debris. 

Surface appearance

Nail Psoriasis tends to change the shape and structure of nails. It weakens your nail plates and causes dents on them. It also leads to partial breakage of nail plates. 

Another common sign is the yellow discolouration on the tip of the nails. This gradually develops and travels all the way to the cuticles. 

When to contact your doctor?

Mostly, people with other types of Psoriasis tend to develop Nail Psoriasis as well. If you experience any of the aforementioned symptoms, you need to see your doctor immediately.

Because the complications of Nail Psoriasis can become critical if left untreated. It can also lead to Psoriasis Arthritis, which is a cause for concern. 

Although there is no permanent cure, with early diagnosis and the right treatments, the symptoms of this skin condition can be highly reduced. 

What are the treatments available for Nail Psoriasis?

Having known that Nail Psoriasis does not have any permanent cure, some treatments ease the symptoms and suffering of those affected by it. Some of them are:

Phototherapy

Phototherapy is the treatment that exposes the affected parts of your body to ultraviolet light A or B. Here, the fingernails or toenails are exposed to ultraviolet light. 

This is done after soaking your fingers or toes in a medication called psoralen which can also be taken orally. This treatment is known as PUVA.

After taking psoralen, your affected nails are exposed to:

• Ultraviolet rays from the sun
• Ultraviolet rays inside a unit situated in a clinic or home
• Laser, especially pulsed dye laser (PDL)

Phototherapy has wide applications when it comes to Plaque Psoriasis, however, this treatment also bears some fruits in the case of Nail Psoriasis. It helps in controlling nail separation and discolouration. 

Medications

In most cases, Nail Psoriasis comes in combination with other forms of Psoriasis, especially, Plaque Psoriasis. Hence, to treat Nail Psoriasis, doctors suggest medications that work throughout your body. 

These medicines are effective in treating the symptoms of Psoriasis in both the skin and nails. The drugs prescribed under this treatment method usually affect your entire body and not just the areas that are affected by Psoriasis. 

Some of the commonly prescribed drugs are:

• Methotrexate
• Cyclosporine (Neoral)
• Biologic
• Retinoid
• Apremilast

Drugs that target your immune system 

Unlike the above group of medications, some drugs interject with your immune system to suppress the symptoms of Psoriasis. Such drugs are usually called immunosuppressants. 

If you take drugs belonging to the above category, they work by inhibiting the normal functioning of your immune system and also slow down it. This reduces the inflammation and prevents the symptoms from getting worse. 

Some of the commonly prescribed immunosuppressants for Nail Psoriasis are:

• Methotrexate
• Cyclosporine

You must note that these drugs come with side effects that can cause adverse effects on you. Hence a proper doctor consultation is necessary before taking them.

Topical medications

 Apart from all these treatments, there are some gels and ointments that you can directly apply to your affected finger and toenails. Your doctor may prescribe one or some of the following topical medications:

• Corticosteroids
• Calcipotriol
• Vitamin D creams
• Retinoid creams

You may have a hard time applying cream or gel to your nails. But regularly applying it will improve the condition of your nails such as nail thickening, fragmentation, etc. 

Your doctor may also suggest nail lacquers that can be applied like nail polish. This also helps in reducing the symptoms of Nail Psoriasis.

Corticosteroid injections 

Corticosteroid injections are preferred to treat localised symptoms of Nail Psoriasis. You will get an injection in the affected areas, for instance, in the nail bed or near the affected nail. 

Yes, it does sound painful. But before the injection, your doctor may use some numbing agent like a localised anaesthetic. 

This comes effective in treating nail ridges, the build-up of materials under the nails, nail separation, nail thickening, etc. 

Nail removal

In some cases, your doctor may suggest removing the affected nails. This can be done by:

• Surgery
• X-ray therapy
• Applying highly concentrated urea in the nails

Home remedies for Nail Psoriasis

Apart from medical treatments and the consumption of drugs, there are different sets of treatments altogether that you can take in your home itself. Some of the effective ones are:

Tea tree oil

Being endemic to the Australian soil, Tea tree oil is preferred all over the world because of its exceptional skin-care properties. Hence it becomes a natural choice to treat Nail Psoriasis with this. 

Its anti-inflammatory properties help reduce the inflammation on the nail beds and the surrounding skin, whereas its antimicrobial properties help fight any possible fungal infections in the nails. 

Aloe Vera gel 

Aloe Vera gel becomes effective when it comes to treating the skin, especially the one affected by Psoriasis. It includes nails as well. 

Applying the gel in between the nail plate and nail bed and the areas surrounding it greatly reduces the inflammation, thickening of nails and the skin, plaque formation, etc.

It highly reduces the Psoriasis flare-ups. The antibacterial properties in aloe vera fight any further infection as people with Nail Psoriasis are more prone to infections. 

For some people, directly applying aloe vera extract may cause skin irritation and redness. In that case, aloe vera gel can be used that is available in the local grocery store. 

Coconut oil

Coconut oil is one of the easily available home remedy products that you can use for treating Nail Psoriasis. It may not be beneficial to bring down the Psoriasis symptoms as a standalone remedy. 

However, you can combine it with some other Psoriasis treatments. For instance, for any steroidal treatment to work well, your skin needs to be well moisturised. In that case, coconut oil may be beneficial. 

In addition, it also helps in controlling inflammation and inhibiting secondary bacterial infections. 

Trim Your Nails Regularly 

Keeping your nails short will be beneficial in reducing some of the symptoms of this skin disease. An overgrown nail paves the way for bacterial or fungal infection in people affected with Nail Psoriasis. 

In addition, keep your nails and nail beds clean by soaking them in an antibacterial solution and cleaning them off. Do not use sharp objects to clean your nails. 

Refrain from biting your nails

If you have Nail Psoriasis, make sure not to bite your nails or pick your cuticles with some sharp objects. Because it may cause infection and leads to Psoriasis flares. 

Also, keeping your nails short helps you prevent any undesired accidental damage along the nail beds from adjacent nails. 

Gentle With Your Nails

Understandably, some may have the urge to bite the cuticles or the build-up under the nails. If you come in that category, well, you may have to restrain yourself from doing that as it may lead to Psoriasis flares.

In addition, do not scrape the build-up under your nails as it may loosen the nails and even lead to further infections. 

Moisturise

Nail Psoriasis makes your skin become too dry. Leaving the skin dry only worsens the condition. Hence it is essential for you to moisturise your skin regularly.

You can use natural moisturisers such as aloe vera or coconut oil. The doctors may also recommend moisturisers that can help soothe your skin. 

Avoid fake nails

Keeping artificial nails to hide the symptoms of Nail Psoriasis is understandable. But it adversely affects you. It may even lead to flare-ups and nail separation. 

Instead of that, you can apply nail polish and do nail buffing to conceal the effects of Nail Psoriasis. 

Keep nails clean and dry

Keeping your finger and toenails clean is indispensable for keeping your psoriasis symptoms from getting worse. As we already know, psoriasis can lead to bacterial or fungal infections, keeping your nails clean will prevent such conditions.

It is equally important that you keep your nails dry. It doesn’t mean that you should not moisturise them. 

Keeping them dry in this context means keeping them from being moist all the time. Because moist nails are susceptible to infections. 

Anti-Inflammatory Foods

Diet also plays a crucial role in controlling the Nail Psoriasis symptoms. Psoriasis is a skin condition that is associated with inflammation throughout the body. 

Hence consuming anti-inflammatory foods help reduce some of its symptoms. Some anti-inflammatory foods that help in this case are:

• Tomatoes
• Olive oil
• Leafy vegetables such as spinach and kale
• Nuts such as almonds and walnuts
• Fatty fish like salmon, tuna, mackerel
• Berry and citrus fruits such as strawberry, blueberry, cherry and orange

Finger Condom

Having Nail Psoriasis may restrict you from performing some tasks. It may also not be feasible to wear gloves all the time. At such times, a finger condom can be helpful. 

A Finger condom is made of water-tight materials such as latex, nitrile rubber and vinyl.

It protects your fingers from open wounds and nail breakage that may worsen the Psoriasis symptoms. You can purchase finger condoms in a local pharmacy store or online. 

Fatty Acids

In many cases, people with Psoriasis are also associated with obesity. Some studies link obesity as one of the risk factors for contracting Psoriasis. 

If you look at the other side, saturated fatty acids contribute greatly to obesity. Hence, there forms a linkage between saturated fatty acids and Psoriasis. 

Since Psoriasis is linked with comorbidities such as cardiovascular illness, saturated fatty acids may induce the severity of such conditions. 

Some other studies show that omega-3 fatty acids play a beneficial role when combined with topical treatments. 

Having said all this, there are yet no conclusive studies that have been carried out in this regard.

Nail Psoriasis Lifestyle  

Although Nail Psoriasis is a chronic disease and has no permanent cure, you can still lead a healthy and quality life by adhering to some healthy lifestyle changes. Some of them are:

Moisturise daily

The benefits of moisturising your skin are re-emphasised because it is one of the habits that keep you from possible flare-ups. Try to use natural and plant-based moisturisers rather than synthetic ones.

Dry your nails properly

As we have already known its importance, keeping your nails hygienic and dry is essential to keep them away from infections. Use soft cotton towels or tissues to dry them and make sure not to rub them forcefully. 

Use gloves

It doesn’t mean that people with Nail Psoriasis cannot indulge in regular physical activities. You can still perform several tasks. But the only thing you need to make sure of is to keep your nails, whether toenails or fingernails, from possible injuries. 

Using gloves can really be beneficial while performing physical tasks. It not only protects your fingernails from injuries but also from infections.

Likewise, protect your toenails with a pair of shoes, preferably a little bigger than your actual foot size. This helps your toenails not get crumbled. 

Sunlight

Exposure to the right amount of sun helps reduce the symptoms of all forms of Psoriasis. Because sunlight contains ultraviolet rays A and B, that is, UVA and UVB. 

In addition, sunlight triggers the production of vitamin D in your body. Vitamin D tends to reduce the inflammation throughout your body; hence it becomes a natural treatment to ease the Psoriasis symptoms. 

However, make sure that you apply sunscreen before exposing yourself to the sun. Also do not stay under the sun for a longer period as it may cause sunburn and other discomforts. 

Improve your diet

Your diet plays a major role in any form of Psoriasis. An unhealthy diet pattern may lead to obesity, which increases the risk of contracting Psoriasis. You can choose the best diet plan that fits your goal by choosing one of the 9 best types of diet. 

In addition, certain foods increase the risk of inflammation. Food items such as red meat, processed meat, foods with trans fats, sugary foods, etc. can cause inflammation. 

Hence you need to avoid such foods and replace them with anti-inflammatory foods such as tomatoes, berries, fatty fish, broccoli, etc. 

Speaking of diets, you also need to be cautious of how much you drink and smoke. These two factors have the potential to aggravate your Psoriasis symptoms. 

Apply nail polish

Nail psoriasis may lead to nail disfigurement. During such times, if you feel uncomfortable going out, you can apply nail polish over your nails. This conceals the nail pits or any dents and cracks that may have developed. 

Humidifier

Keeping yourself from getting dry prevents any aggravation of Psoriasis symptoms including Nail Psoriasis. Some experts suggest that maintaining a humidity of 30 to 50% inside the house is ideal for people with Psoriasis.

This is where the humidifier comes into the picture. It helps maintain constant humidity inside your house. Its application can be well appreciated during the winter months. 

It helps your skin from getting too dry, which may worsen the Psoriasis symptoms.

Risk of nail psoriasis

A major proportion of people who have Plaque Psoriasis contract Nail Psoriasis at some point in their lives. If you develop this skin condition, it is essential for you to treat its symptoms as soon as possible. 

Because Psoriasis is associated with its comorbidities. People with Psoriasis also develop risks of heart illnesses, metabolic syndrome, Psoriatic Arthritis, etc. 

In addition, Nail Psoriasis makes your nails susceptible to Nail Fungus and other bacterial infections as well. Hence early intervention is crucial for Psoriasis. 

To sum up

Nail Psoriasis is often associated with Plaque Psoriasis. If you develop Plaque Psoriasis, make sure to treat your symptoms at an early stage to prevent Nail Psoriasis. 

But, even if you contract Nail Psoriasis, with proper treatments and home remedies, you can suppress its symptoms to a greater level. Keep in mind that early medical intervention is the key to keeping the symptoms in check. 

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