Nail psoriasis is a chronic condition that affects the nails, causing them to thicken, discolor, and develop ridges.

It is a form of psoriasis, which is an autoimmune disease that causes the skin cells to multiply rapidly, resulting in the formation of thick, scaly patches on the skin. Nail psoriasis affects approximately 50% of individuals with psoriasis and can significantly impact the quality of life. In this article, we will explore the symptoms and treatment options available for nail psoriasis.

Symptoms of Nail Psoriasis:

Nail psoriasis can manifest in various ways, and the severity of symptoms can range from mild to severe. Here are some common symptoms associated with nail psoriasis:.

1. Pitting:

Pitting is one of the hallmark signs of nail psoriasis. It is characterized by the presence of small depressions or indentations on the surface of the nails. These pits can be shallow or deep and may affect one or several nails.

Pitting occurs due to the abnormal growth and proliferation of skin cells underneath the nail.

2. Onycholysis:

Onycholysis refers to the separation of the nail from the nail bed. In nail psoriasis, the nails become loose and detach from the underlying skin, leading to the formation of empty spaces between the nail and the nail bed.

This condition can cause pain, discomfort, and an increased risk of nail infections.

3. Nail plate crumbling:

Nail plate crumbling is another common symptom of nail psoriasis. It is characterized by the crumbling or disintegration of the nail plate. The nails may become brittle, break easily, and develop irregular edges.

This condition can make it challenging to perform everyday activities and can have a significant impact on a person’s self-esteem.

4. Nail discoloration:

Nail psoriasis can cause the nails to change color. The affected nails may appear yellowish, brownish, or even greenish. This discoloration occurs due to the buildup of skin cells and inflammation underneath the nail.

5. Thickened nails:

In nail psoriasis, the nails can become thickened and hypertrophied. The increased thickness is a result of the abnormal growth and accumulation of skin cells. Thickened nails can be difficult to trim and maintain and may cause discomfort or pain.

6. Nail ridges:

Nail ridges are lines or indentations that run vertically or horizontally along the nails. In nail psoriasis, these ridges can become more pronounced and prominent. They may be grooved, raised, or develop a wavy pattern.

Nail ridges can affect the appearance of the nails and make them more susceptible to breakage.

7. Subungual hyperkeratosis:

Subungual hyperkeratosis refers to the buildup of keratin underneath the nails. It can cause the nails to lift or separate from the nail bed and can result in the formation of thick, chalky or crumbly material.

Subungual hyperkeratosis can lead to pain, discomfort, and an increased risk of nail infections.

8. Nail psoriasis without skin involvement:

It is possible to have nail psoriasis without any significant skin involvement. In such cases, the nails may be the only affected area.

It is essential to distinguish nail psoriasis from other nail conditions, such as fungal infections or trauma, to ensure appropriate diagnosis and treatment.

Treatment Options for Nail Psoriasis:

While nail psoriasis can be challenging to treat, various treatment options can help manage the symptoms and improve the appearance and function of the nails.

The choice of treatment depends on the severity of the condition, patient preferences, and the presence of any associated skin psoriasis. Here are some commonly used treatment options for nail psoriasis:.

1. Topical treatments:

Topical treatments are often the first line of treatment for nail psoriasis. They are applied directly to the nails and include corticosteroids, vitamin D analogs, and tar-based preparations.

These medications help reduce inflammation, normalize the growth of skin cells, and improve the overall appearance of the nails.

2. Intralesional corticosteroid injections:

In cases of severe nail psoriasis or when topical treatments are ineffective, intralesional corticosteroid injections may be recommended.

A corticosteroid solution is injected directly into the affected nail bed, leading to a reduction in inflammation and improvement in nail symptoms. This treatment option requires specialized training and should be performed by a healthcare professional.

3. Oral medications:

In some cases, oral medications, such as retinoids or immunosuppressants, may be prescribed for the treatment of nail psoriasis. These medications work by modulating the immune system and reducing inflammation.

However, they can have potential side effects and should be used under close medical supervision.

4. Phototherapy:

Phototherapy involves exposing the affected nails to natural or artificial ultraviolet (UV) light. This treatment option can help slow down the rapid growth of skin cells, reduce inflammation, and improve nail symptoms.

However, regular and consistent sessions may be required to achieve significant improvement.

5. Systemic biologic therapies:

Systemic biologic therapies are a relatively newer treatment option for nail psoriasis.

These medications, including TNF-alpha inhibitors, IL-17 inhibitors, and IL-23 inhibitors, target specific molecules involved in the autoimmune response, leading to a reduction in inflammation and improvement in nail symptoms. They are usually reserved for severe cases and require close monitoring due to potential side effects.

6. Nail care strategies:

Along with medical treatments, adopting certain nail care strategies can help manage nail psoriasis. This includes keeping the nails trimmed short, avoiding harsh nail products or chemicals, and protecting the nails from trauma or injuries.

Moisturizing the nails and surrounding skin regularly can also help prevent dryness and improve the overall health of the nails.

7. Lifestyle modifications:

Managing stress levels, following a healthy diet, and engaging in regular physical activity can play a supportive role in managing nail psoriasis.

While lifestyle modifications alone may not result in a complete resolution of symptoms, they can contribute to overall well-being and potentially improve treatment outcomes.

8. Nail camouflage:

In cases where nail psoriasis causes significant cosmetic concerns, nail camouflage techniques can be used. Nail polishes or gels specifically designed to conceal nail abnormalities can help improve the appearance and boost self-confidence.

These products do not treat the underlying condition but provide temporary aesthetic benefits.

The Bottom Line:

Nail psoriasis is a chronic condition that can significantly impact the quality of life. It is essential to recognize the symptoms and seek appropriate treatment to manage the condition effectively.

A combination of medical treatments, nail care strategies, and lifestyle modifications can help alleviate symptoms, improve the appearance of the nails, and enhance overall well-being in individuals with nail psoriasis.