nail psoriasis and psoriatic arthritis
If you have psoriatic arthritis (PsA), chances are good that it’s affected your nails. Not only is nail psoriasis an early sign of PsA, it’s the most common symptom of the disease. Psoriatic arthritis is a type of inflammatory arthritis that occurs in some people with psoriasis, a condition that causes the overproduction of skin cells, which often results in dry red patches with thick silvery scales.
Up to nearly 90 percent of people with PsA have nail involvement. “Both fingernails and toenails can be affected, and it can affect one nail or all 20 nails, ” says Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine. But considering how distorted nails can become when you have psoriatic arthritis, even one affected nail can be one too many.
These depressions on the nail are the most common symptom of PsA, occurring in more than two-thirds of people with the disease, according to the Psoriasis and Psoriatic Arthritis Alliance. They can be small and shallow or big and deep.
Nail Unit Psoriasis (nail Psoriasis)
This is the gradual (and, thankfully, painless) separation of a nail from the underlying nail bed. The pocket created can form a pathway for bacteria or fungi to infect the nail bed. About one-third of people with nail psoriasis develop a fungal infection.
The buildup of skin cells creates a flaky or chalky substance (doctors often refer to it as debris) that accumulates under the nail. It’s more of an issue in toenails because the constant pressure from wearing shoes can become uncomfortable.
Inflammation of the matrix, the area at the base of the nail where the cells that produce new nail growth are produced, can cause these grooves and ridges that run lengthwise and are known as Beau’s lines. They usually occur on every fingernail or toenail.
Nail Psoriasis: Causes, Symptoms, Diagnosis, Treatment
Skin and nails are made of the same protein, so the rapid, excess growth of skin cells can also cause nails to grow too quickly and/or too thickly.
White, yellow, or brown discoloration and/or reddish marks (aka splinter hemorrhages, which are caused by tiny burst blood vessels under the nails) are common among people with psoriatic arthritis.
The good news is that there are many treatments for nail psoriasis: The two mainstays are topical steroids and the vitamin D-based treatment calcipotriene. Treatments like biologics and retinoids — which work throughout the body — can also treat both your skin and nails.
Psoriasis And Joint Pain
The bad news is that treating nail psoriasis can be tough as, well, nails. The condition can be stubborn, so you may need to use more than one treatment. Nails also grow slowly, so even if a treatment works, it can take a while — up to a full year for fingernails, and two years for toenails, to grow out — before you’ll see the full benefit. That can be a long time to wait when your nails look distorted.
Damage or injury to the nails can cause or worsen nail psoriasis. Any sort of physical trauma can lead to what’s called the Koebner phenomenon. This is when you get a flare where the skin or nail has been injured. Keeping nails short can minimize trauma from everyday tasks. It can also help prevent nails from lifting off of fingers and toes and discourage buildup under the nails.
This includes housework, yard work, and home repairs. Any time you irritate your skin or nails, psoriasis can flare. When doing wet work like washing dishes, it’s best to wear a cotton glove and then place a vinyl or nitrile (synthetic rubber) glove over it. According to the American Academy of Dermatology, latex gloves don’t give your nails enough protection. Keeping nails dry can also make infections less likely.
Psoriatic Arthritis Nail Changes: Symptoms And Treatments
“‘Fancy nails’ like acrylic, gel, or artificial nails, are traumatic for nails, ” says Dr. Gohara. “They grind down your nails to apply them and use harsh chemicals to remove them, both of which can damage your nail.” Don’t create more damage than you need to.
Nail polish and/or a nail hardener can be used to conceal pitting and other signs of psoriasis and help to protect nails, just check with your doctor first to be sure they’re appropriate for your nails.
Removing the buildup can loosen nails and increase your risk of getting an infection. With treatment, the buildup should gradually clear. In the meantime, soaking the affected nails in soapy warm water may be sufficient to remove the debris.
How Does Psoriatic Arthritis Affect Nails?
Learn more about the range of symptoms you can experience with psoriatic arthritis. For more audio guides and insights from PsA experts, check out the Psoriatic Arthritis Club podcast.
Get the latest arthritis news in your inbox. Sign up for and hear about the latest research updates and medical news that could affect you.
Is a digital community for millions of arthritis patients and caregivers worldwide who seek education, support, advocacy, and patient-centered research. We represent patients through our popular social media channels, our website , and the 50-State Network, which includes nearly 1, 500 trained volunteer patient, caregiver and healthcare activists.Nail psoriasis is an autoimmune condition. It causes discoloration, pitting and changes in your fingernails and toenails. There isn’t a cure, but treatments can alleviate related symptoms.
Nail Psoriasis: An Updated Review And Expert Opinion On Available Treatments, Including Biologics
Nail psoriasis is an autoimmune disease that causes your skin cells to reproduce quickly. It’s a type of psoriasis that affects the nails on your fingers and toes.
Nail psoriasis is common. It affects over 50% of all people with psoriasis and around 86% of all people with psoriatic arthritis.
No, nail psoriasis isn’t a fungus. Nail psoriasis is an autoimmune disease. Your immune system overreacts, which leads to new skin cells growing too fast.
New Research Into Psoriatic Arthritis
Some of these symptoms may result in discomfort, tenderness or pain that can affect your comfort or ability to stand, walk or use your hands.
Nail psoriasis is an immune system problem. Typically, new skin cells grow every 28 to 30 days. However, in people with psoriasis, new cells grow and move to the skin surface every three to four days, which creates a skin rash. In some people with psoriasis, it affects their nails in addition to their skin or other parts of their bodies.
Your healthcare provider can typically diagnose nail psoriasis after a physical exam. They’ll examine your affected areas to look for common signs of nail psoriasis. They’ll also ask about your symptoms and your family history.
People With Nail Psoriasis May Have A Higher Chance Of Developing Psa
Once your healthcare provider has diagnosed nail psoriasis, they may use the nail psoriasis severity index (NAPSI) to grade its severity. The NAPSI uses imaginary lines to divide your nail into four even sections (quadrants). Your nails receive a 0-4 score based on the presence of any nail psoriasis symptoms in each of the quadrants. Your healthcare provider will then add the scores together. A low number means your nail psoriasis is mild, and a high number means your nail psoriasis is more severe.
If there’s any doubt about your symptoms, your healthcare provider may order a potassium hydroxide (KOH) preparation or fungal culture to rule out a fungus as the cause of your symptoms. If those test results aren’t clear, a fungus test known as a periodic acid-Schiff (PAS) stain can also determine the presence of a fungus.
There isn’t a cure for nail psoriasis. It’s a long-lasting (chronic) condition, which means flare-ups can occur throughout your life. You may have flare-ups and times when the symptoms go away (remission). Treatments can provide relief for your symptoms.
How To Care For Nails Affected By Psoriatic Arthritis
Nail psoriasis is often resistant to some treatment options, so it can be challenging to manage without standard treatment. You and your healthcare provider may have to explore different treatment options, including:
While home remedies are safe for most people, it’s a good idea to check with your healthcare provider before trying some of the following options. You may be at risk of developing an allergic reaction.
If your nail psoriasis makes you feel self-conscious or embarrassed, you may gently buff your nails and apply nail polish to hide any pits or discoloration and improve your nails’ appearance. However, avoid using fake nails. Fake nails can damage your actual nails.
When Psoriasis Picks On Your Nails
There isn’t any way to prevent nail psoriasis. If you have nail psoriasis, it may come and go throughout your life. Treatments can reduce symptoms, even in people with severe nail psoriasis.
Nail psoriasis is an autoimmune disease that causes discoloration, pitting and changes in the structure of your nails. It can make you feel self-conscious, though you can buff your nails and apply nail polish to improve their appearance. Nail psoriasis isn’t contagious, and treatments can help your symptoms improve.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. PolicyPsoriatic arthritis can cause nail problems ranging from mild to severe. Find out how to spot signs of trouble, explore treatment options, and protect your nails every day.
Efficacy Of Adalimumab For Nail Psoriasis During 24 Months Of Continuous Therapy
Psoriatic arthritis is best known for the damage it can do to your joints, but changes to your nails — both fingernails and toenails — can also signal that something is amiss inside your body.
Nail problems are a predictor of psoriatic arthritis as well as a common
