Psoriasis is a chronic autoimmune disease that affects the skin and joints. One of the lesser-known symptoms of psoriasis is nail involvement, known as psoriatic nails.

Psoriatic nails occur in up to 50% of individuals with psoriasis and can have a significant impact on quality of life. Here’s what you need to know about psoriatic nails, including signs, symptoms, and management.

What are Psoriatic Nails?

Psoriatic nails are a manifestation of psoriasis that affect the nails. They can be characterized by various changes in the nail, including:.

Pitting (small indentations on the surface of the nail)
Discoloration (yellow-brownish discoloration of the nail)
Onycholysis (separation of the nail from the nail bed)
Thickening of the nail plate
Subungual hyperkeratosis (scaling under the nail)
Nail dystrophy (irregular growth and shape of the nail)
Beau’s lines (indentations that run horizontally across the nail)

While psoriatic nails are often painless, they can cause significant cosmetic concerns and can affect daily activities such as nail grooming and household tasks.

Signs and Symptoms

Psoriatic nails can develop suddenly or slowly over time, and not all nails may be affected. The severity of nail involvement can vary widely, from mild to severe. Common signs and symptoms of psoriatic nails include:.

Pitting – small pits or depressions on the nail surface, often multiple in number
Discoloration – yellow-brown nails
Onycholysis – separation of the nail from the nail bed
Thickening of the nail plate
Subungual hyperkeratosis – scaling under the nail
Nail dystrophy – irregular nail growth, shape, and texture
Beau’s lines – ridges or indentations across the nail plate
Nail crumbling
Nail pain or tenderness
Loose nails – may fall off completely

If you notice any of these changes in your nails, it’s important to see a dermatologist for proper diagnosis and treatment.

Causes of Psoriatic Nails

The exact cause of psoriatic nails is unknown, but it is thought to arise from a combination of genetic and environmental factors.

Psoriatic nails are more common in individuals with psoriasis, although they can occur in isolation without skin involvement. Other factors that can contribute to the development of psoriatic nails include:.

Fungal infections – can damage the nails and trigger psoriasis
Physical trauma to the nail – can trigger the development of psoriatic nails in susceptible individuals
Smoking – can increase the risk of developing psoriatic nails
Alcohol consumption – can increase the severity of psoriasis and psoriatic nails

Psoriatic nails are not contagious and cannot be passed from person to person.

Diagnosis and Treatment of Psoriatic Nails

If you suspect you have psoriatic nails, it’s important to see a dermatologist for proper diagnosis and treatment.

Your dermatologist will examine your nails and may perform additional tests, such as a nail biopsy or KOH (potassium hydroxide) test to rule out fungal infection.

Treatment for psoriatic nails may include:.

Topical treatments – vitamin D analogs, corticosteroids, calcineurin inhibitors
Systemic therapies – methotrexate, cyclosporine, biologic agents
Oral retinoids – may improve nail dystrophy and pitting but require close monitoring
Light therapy – can improve nail psoriasis in some individuals

Your dermatologist will develop a personalized treatment plan based on the severity of nail involvement and other factors such as your overall health and medical history.

Management of Psoriatic Nails

While there is no cure for psoriatic nails, there are several self-care measures that can help manage symptoms and improve the appearance of nails:.

Keep nails short and trimmed – avoid biting or picking at nails which can worsen nail psoriasis
Avoid tight-fitting shoes and gloves that can cause friction and trauma to the nails
Protect nails from physical trauma and injury – wear gloves while doing household chores or yard work
Avoid smoking and alcohol consumption
Moisturize the nails and surrounding skin daily
Wear breathable shoes and socks to prevent sweating and fungal infections
Consult with a dermatologist before undergoing any nail treatments such as nail polish, nail acrylics, or artificial nails which can worsen nail psoriasis

Psoriatic nails can be challenging to manage, but with proper care and treatment, it is possible to improve the appearance and function of affected nails.

Conclusion

Psoriatic nails are a common yet often overlooked symptom of psoriasis that can have a significant impact on quality of life.

Signs and symptoms of psoriatic nails can vary widely, and early diagnosis and treatment are essential to prevent further nail damage. Proper management of psoriatic nails, including self-care measures and medical treatment, can help improve symptoms and restore the function and appearance of affected nails.