Psoriasis is a chronic autoimmune condition that affects the skin, but it can also impact the nails. Nail psoriasis can cause changes in the appearance and texture of the nails, as well as discomfort and pain. This guide will provide information on how to diagnose and treat psoriasis on nails.

Understanding Nail Psoriasis

Psoriasis in nails, also known as nail psoriasis, is a common condition that affects up to 50% of people with psoriasis. It is more common in those with plaque psoriasis than in other types. Nail psoriasis tends to develop years after an individual has begun to experience psoriasis.

Symptoms include:

-Pitting/Dents

-Discomfort

-Weakening/Crumbling nails

-Build-up or blood underneath the nail

-Discolouration- White, yellow, or brown marks

-Thickening

-Separation of the nail from the nail bed

-Pain- in more severe cases

-Trouble performing everyday tasks- again in severe cases

It's important to understand the symptoms and treatment options for psoriasis in nails in order to manage the condition effectively.

Diagnosis of Psoriasis in Nails

The diagnosis of psoriasis in nails is typically made by a dermatologist or doctor who specialises in skin conditions. They will visually examine the affected nails and may take a sample of the nail to be analysed in a laboratory. In some cases, a skin biopsy may also be performed to confirm the diagnosis. It's important to seek medical attention if you suspect you have psoriasis in your nails, as early diagnosis and treatment can help prevent further damage to the nails. Professional treatment can prevent nail psoriasis from worsening, approve the appearance of your nails, and stops any associated pain. A doctor will also check for signs of infection, which can be linked to nail psoriasis.

Nail psoriasis can also be an early symptom of psoriatic arthritis, so early diagnosis and medical monitoring are key. Again, early treatment of psoriatic arthritis can stop the condition from worsening.

Treatment Options for Psoriasis in Nails

There are several treatment options available for psoriasis in nails, including topical medications, oral medications, and light therapy. Topical medications, such as corticosteroids and calcipotriene, are often the first line of treatment and can be applied directly to the affected nails. Oral medications, such as methotrexate and cyclosporine, may be prescribed for more severe cases. Light therapy, also known as phototherapy, involves exposing the affected nails to ultraviolet light and can be effective in reducing inflammation and promoting healing. Your doctor can help determine the best treatment option for you based on the severity of your condition and your overall health. Remember, nails grow pretty slowly, so treatment will take some time. Your doctor may recommend trying a treatment for up to 6 months.

Topical Treatments for Psoriasis in Nails

Topical treatments are often the first line of defense for psoriasis in nails. These medications are applied directly to the affected nails and can help reduce inflammation and promote healing. Corticosteroids, such as clobetasol and betamethasone, are commonly prescribed and can be effective in reducing redness, swelling, and itching. These are used once or twice a day. Calcipotriene, a vitamin D analog, can also be used to treat psoriasis in nails and works by slowing down the growth of skin cells. Other topical treatments, such as tazarotene and anthralin, may also be prescribed by your doctor.

Systemic Treatments for Psoriasis in Nails

In some cases, topical treatments may not be enough to effectively treat psoriasis in nails. In these situations, systemic treatments may be recommended by your doctor. These treatments are taken orally or by injection and work throughout the body to reduce inflammation and slow down the growth of skin cells. Some common systemic treatments for psoriasis in nails include methotrexate, cyclosporine, and biological medications such as adalimumab and ustekinumab. It’s important to discuss the potential risks and benefits of these treatments with your doctor before starting any new medication, as many of these do have side effects to consider.

Prevention Tips for Psoriasis in Nails

While there is no guaranteed way to prevent psoriasis in nails, there are some steps psoriasis sufferers can take to reduce their risk:

- Maintain good nail hygiene- The presence of nail abnormalities can make it difficult to clean the nails effectively. As a result, bacteria, dirt, and debris can accumulate, increasing the risk of infection and further complicating the underlying psoriasis condition. Moreover, the physical discomfort caused by nail psoriasis can discourage regular nail care routines, exacerbating hygiene concerns. When cleaning nails affected by psoriasis, it is crucial to use a gentle approach. Mild, fragrance-free soaps and lukewarm water can be used to clean the nails. Avoid vigorous scrubbing or harsh chemical cleaners, as they may aggravate the condition. Regular nail trimming and filing can help manage nail psoriasis. Use sharp, clean nail clippers to avoid splitting or damaging the nails. Gentle filing can smooth out any rough edges and prevent snagging, reducing the risk of additional complications.

-Moisturise- Hydration plays a vital role in managing nail psoriasis. Applying moisturiders or emollients to the nails and surrounding skin can help reduce dryness and prevent cracking. Look for products containing ingredients like urea or salicylic acid, which can help soften and exfoliate the nails gently.

- Avoid trauma to the nails: Try to avoid injuring your nails, as this can trigger psoriasis symptoms. Always handle your nails with care, as excessive pressure or force can worsen nail psoriasis symptoms. Use nail clippers with a straight edge. Avoid overly round or pointed nail shapes, as these can increase the risk of nail trauma. File your nails with a fine-grit file, working in one direction to prevent nail splitting or rough edges. Be cautious while pushing back your cuticles, using a soft cuticle stick. Avoid excessive force, and never cut or trim your cuticles, as this can lead to infections.

Take Care Whilst Performing Everyday Tasks- Wear gloves when engaging in activities that put your nails at risk, such as gardening or cleaning. This will help minimise contact with harsh chemicals and prevent nail trauma. Avoid using your nails as tools, such as for opening cans or packages, to reduce the risk of nail damage. When performing repetitive tasks, like typing or playing musical instruments, take regular breaks to relieve extra pressure on your nails. Avoid prolonged exposure of your nails to water, as it can cause them to become soft and more prone to injury. Wear protective gloves while doing household chores involving water.

-Nail-Friendly Nail Polish- Choose nail polishes labeled as "5-free" or "8-free," which indicates they are free from harmful chemicals like formaldehyde, toluene, or DBP (dibutyl phthalate). These chemicals can be harsh on your nails and potentially aggravate psoriasis symptoms.

- Get Regular Exercise- Regular exercise can be a valuable tool in managing and alleviating the symptoms of nail psoriasis. Regular exercise stimulates blood flow, which can be beneficial for individuals with nail psoriasis. Improved circulation nourishes the fingernails with essential nutrients and oxygen, aiding in their overall health. This increased blood flow may also aid in the removal of waste products from the affected area, potentially reducing inflammation and promoting healing.

- Maintain a Healthy Weight- Excess weight can put a strain on the joints of the fingers and toes, potentially aggravating nail psoriasis. By losing weight and relieving some of the pressure on these joints, the condition's impact on the nails may be reduced.

- Quit Smoking- Smoking involves inhaling nicotine, a potent vasoconstrictor that narrows blood vessels. Reduced blood flow to the extremities can compromise nail health, leading to nail psoriasis development or worsening. The influence of nicotine on the immune system might additionally contribute to inflammation. The toxic substances present in tobacco smoke can also disrupt the normal functioning of the immune system, potentially triggering or exacerbating nail psoriasis. The toxic constituents of cigarette smoke, including polycyclic aromatic hydrocarbons and heavy metals, may have direct effects on nail health. These harmful chemicals can infiltrate the nails, causing damage and triggering inflammatory responses, potentially aggravating nail psoriasis symptoms.

-Avoid Excessive Alcohol Consumption- Alcohol can act as a trigger for inflammatory responses, making psoriasis symptoms worse, including those affecting the nails. Alcohol can also dehydrate the body, leading to dryness in the skin and nails, which can intensify the discomfort caused by nail psoriasis.

- Manage Stress- While the exact cause of nail psoriasis is complex and multifactorial, stress has long been recognised as one of the triggers that can worsen the condition's severity and frequency of outbreaks. When an individual experiences chronic stress, it can weaken the immune system and disrupt the natural balance of the body. This can contribute to the onset or worsening of various autoimmune conditions, including nail psoriasis. Stress can also weaken the body's ability to heal, making it more difficult to manage and control nail psoriasis symptoms.

- Eat a Healthy Diet- While diet alone cannot cure nail psoriasis or any other autoimmune condition, certain dietary factors may influence its severity and overall management. Research suggests that an anti-inflammatory diet can help reduce the frequency and intensity of nail psoriasis flare-ups.