Psoriasis of the Nails
Inflammatory Skin Condition Causes Cosmetic and Functional Problems
May 26, 2009
Psoriasis occurs when skin cells grow too quickly due to a fault in the immune system. The most common form appears as dry red patches, which may be itchy or sore, covered with dead skin cells called ‘scale’. Various parts of the body can be affected, especially the elbows, knees and scalp. Most people with psoriasis also experience problems with their nails at one time or another.
Symptoms of Nail Psoriasis
- Small pits may be seen in the surface of the nail, where weakened areas have dropped off.
- Grooves across the width of the nail indicate past episodes of inflammation in the cuticle.
- Psoriasis of the nail bed (the skin beneath the nail) may look like a drop of oil or blood visible through the nail.
- An affected nail may separate from its bed. This usually starts at the tip and progresses towards the cuticle. It may be first apparent when white areas become visible beneath the nail; these are bubbles of air that has entered into the gap. Dirt and debris may also become trapped, carrying a risk of infection.
- Scale may build up on the nail bed in the same way that it does on patches of psoriasis elsewhere on the body. Because of the presence of the nail, however, this scale cannot fall off. Instead, it accumulates over time, gradually lifting the nail from its bed.
- The nail itself may become yellow and crumbly over time.
- Severely affected nails may fall off altogether.
- People with nail psoriasis may also develop arthritis of the fingers and toes.
Managing Nail Psoriasis
It is important to see your doctor if you have any worries about changes in your nails. He or she may take a small sample of skin from beneath the nail to test for psoriasis. There is no cure for the condition at present, but treatments are available to improve the function and appearance of affected nails.
Always try to avoid bumps and scrapes to the nails – and never pick at them. Even minor damage or infection can worsen their condition. Keep your nails short and wear gloves for household chores and other wet or dirty tasks. Use a soft nail brush to clean the nails rather than a pointed or metal tool.
Pits are usually a cosmetic problem and may be concealed with nail colour, though this can cause problems of its own.
Your doctor may prescribe a cream or ointment to rub into your nails. Topical treatments such as corticosteroids and vitamin D derivatives slow the growth of skin cells in the area where they are applied. Treatment with natural or artificial light (phototherapy) is another option for less severe nail psoriasis. Phototherapy may be combined with drug treatment to improve its effectiveness.
Very severe cases that are causing significant disability may be treated with drugs taken orally or an injection into the base of the nail. These medications can have serious side-effects, however, so are not used for prolonged periods of time.
Living With Nail Psoriasis
Nail problems are common in psoriasis. There is no cure at present, but people with nail psoriasis can help their condition by treating their nails gently, and medical help is available to control the symptoms.
References
NHS Choices: Psoriasis. Accessed 27-05-09
PsoriasisNet. Accessed 27-05-09
Disclaimer
The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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