I wish I’d had those handshake alternatives when I was a young pastor eager to hide my hand and nail psoriasis. My challenges with nail psoriasis date all the way back to elementary school. I remember desperately scraping my fingernails to try to rid them of pits and grooves, but that didn’t work. So I would unconsciously turn my thumbs into my palms to conceal the nails. While my chronic condition is much better now thanks to effective treatment, I still live with active psoriasis on most of my fingernails and toenails. According to studies, I’m not alone.
Who Gets Nail Psoriasis
If you have psoriatic disease, you might wonder if you’ll get nail psoriasis. Studies cited by the National Psoriasis Foundation (NPF) show that roughly 50 percent of people with psoriasis have it on their nails and that an estimated 90 percent will experience nail psoriasis in their lifetime. An article on nail psoriasis treatment options in the journal Drugs notes that “nail involvement affects 80 to 90 percent of patients with plaque psoriasis, and is even more prevalent in patients with psoriatic arthritis.” When I read another journal article on the strong correlation between nail psoriasis and psoriatic arthritis, I asked my dermatologist whether she thought I had reason for concern. She gave me a referral to a rheumatologist for a psoriatic arthritis assessment. No, I did not have psoriatic arthritis, but I’m glad I voiced my worries. If you have any questions about whether your nail psoriasis might be a sign of psoriatic arthritis, be sure to bring them up with your healthcare team.
My Nail Psoriasis Symptoms
The website of the American Academy of Dermatology (AAD) lists the common signs of nail psoriasis, along with photos for each. These include:
Nail pits that look like dents in the nailsDiscoloration of the nails with areas of white, yellow, or brownCrumbling nailsSeparation of the nail from the nail bed (onycholysis)Thickening or bleeding underneath the nail plate
Not surprisingly, at one time or another all my nails have exhibited these signs of psoriasis. In addition to the embarrassment of nail psoriasis, I’ve experienced a great deal of pain and discomfort. Inflamed cuticles at the base of my nails have itched and burned. Nails have lifted, cracked, and broken from the end down to the base. To avoid further nail pain or damage, I learned not to put my hand into a tight or dark spot, like a box or a drawer. It’s hard to forget the sharp, sudden pain of a raised nail or swollen cuticle tearing on something unseen. Pulling on socks became an ordeal when a raised or cracked toenail caught fabric.
Nail Psoriasis Treatment
Looking at my nails now I’m grateful that they aren’t as deformed or painful as before. Today I use an injectable biologic for my skin psoriasis that also helps my nail psoriasis. I also apply a topical corticosteroid to the base of an inflamed nail. The AAD lists treatments available for nail psoriasis. Some can be applied directly to the nail at home or the dermatologist’s office, while others that work throughout the body come in the form of pills and injections. Over the years I’ve tried all kinds of systemic medications, including pills like methotrexate and cyclosporine. Some didn’t help my nail psoriasis at all, while others varied in effectiveness. Treating my nail psoriasis has taken patience, trial and error, and close collaboration with my dermatologist. “Nail changes may occur on the nail plate or in the nail bed or nail matrix,” the NPF says. “Where the nail is affected can determine which treatment may be most effective. Your healthcare provider will discuss your treatment options.”
Tips to Live Better With Nail Psoriasis
The AAD also provides a list of nail-care tips that can make nail psoriasis easier to live with. Here are a few that I follow regularly:
Keep nails short to help ensure they don’t catch and lift.File nails so no sharp edges damage skin.Wear gloves (cotton-lined gloves inside work gloves) when doing housework.
In addition, when my nail psoriasis flares, my wife and kids take care of my chores such as cleaning bathrooms. It’s hard to ask for help when I want to be self-sufficient, but it’s better to not irritate my psoriasis. Today living with nail psoriasis is not as challenging for me as in years past. More effective psoriasis treatments have improved my nails, and with age I’ve become less self-conscious. I don’t hide my thumbs anymore or avoid shaking hands. But those pits and marks remind me that the nail psoriasis is still there. You can read more about my experiences on my website, PsoHoward.
