Or, you may be among a minority of people — around 5 percent, according to a study published in August 2020 in the journal EMJ Dermatology — who develop nail psoriasis without first developing other forms of the disease. However your nails come to be affected by psoriasis, you might contend with a number of unsightly symptoms. And while less-than-perfect nails may not seem like a big concern, looks aren’t the only problem: The symptoms can often make certain tasks hard to do. For people with skin psoriasis, nail symptoms can also be a sign of psoriatic arthritis, according to Marisa Garshick, MD, an assistant clinical professor of dermatology at Weill Cornell Medical Center and a dermatologist at MDCS Dermatology in New York City. For that reason, if you have skin psoriasis and notice changes to your fingernails or toenails, it’s important to see your dermatologist right away.
What Nail Psoriasis Looks — and Feels — Like
As with all types of psoriasis, nail psoriasis is caused by inflammation, says Dr. Garshick. That inflammation can impact the nail matrix — the area beneath the cuticle where the nail starts — which can affect how the nail grows out. The soft tissue underneath the nail (the nail bed) can also be affected, as can the skin around the nail, which can easily be mistaken for other nail conditions, such as an injury to the affected nails or a fungus. Nail psoriasis symptoms largely aren’t painful, just noticeable, although “Some people can experience tenderness or sensitivity,” Garshick says. The symptoms of nail psoriasis can include:
Nail pitting This refers to tiny dents that form on the surface of the nail.Nail crumbling The nails themselves can start to break apart, which can affect day-to-day functions such as using a computer keyboard.Onycholysis, or lifting of the nail away from the nail bed Thickening of the nail can cause it to separate from the finger or toe, which makes it more likely to catch on something and lift up or break off.Leukonychia, or tiny white dots on the surface of the nail Inflammation causes this discoloration.Salmon spots or oil spots Yellow-red discolorations form on the nail bed and look like a drop of oil under the nail.
These symptoms can appear on fingernails, toenails, or both, but not every fingernail or toenail may be affected.
Treatment and Self-Care
Caring for nail psoriasis typically involves both medical care and self-care. Your dermatologist will base your medical treatment on which part of the nail is affected: the matrix or the nail bed. Although cortisone injections to the nail may be used, Garshick says they don’t always work. Treating the underlying inflammation in the body with a systemic drug, such as a biologic, may be more effective. Good nail hygiene is important for keeping your hands healthy when you have nail psoriasis. These tips can help: Finally, nail psoriasis can take years to develop. “Your fingernails and toenails can take anywhere from 6 to 12 months to grow out fully,” Garshick says. Once you’re diagnosed with psoriasis or psoriatic arthritis, it’s important to stick to your treatment plan. Doing so may be all it takes to prevent the condition from creeping into your nails.
