Nail psoriasis is a common manifestation of psoriasis that affects the fingernails and toenails. It causes various changes in the nail structure and appearance, often leading to discomfort and cosmetic concerns.
🦠 What is Nail Psoriasis?
- A chronic inflammatory condition involving the nails
- Often occurs in people with psoriasis of the skin
- Can affect one or multiple nails
🔍 Common Nail Changes in Psoriasis
| Feature | Description |
|---|---|
| Pitting | Small, shallow pits or depressions on the nail surface (like “pinholes”) |
| Onycholysis | Separation of the nail plate from the nail bed, creating a white or yellow area |
| Subungual hyperkeratosis | Thickening of skin under the nail causing the nail to lift |
| Oil drop/salmon patch | Yellow-red discoloration visible through the nail plate |
| Nail plate crumbling | Brittle, fragile nails that break easily |
| Beau’s lines | Horizontal grooves or ridges on the nail |
| Nail thickening | Nails may become abnormally thickened |
⚠️ Symptoms
- Nail pain or tenderness (especially if nail lifts)
- Cosmetic changes causing distress
- Nail brittleness or splitting
- Increased risk of secondary fungal infections
🧬 Causes & Risk Factors
- Genetic predisposition
- Immune system dysfunction causing rapid skin cell growth
- Presence of skin psoriasis or psoriatic arthritis
- Nail trauma can trigger or worsen nail psoriasis
🛠️ Diagnosis
- Clinical examination
- Patient history of psoriasis or family history
- Nail biopsy in uncertain cases
- Rule out fungal infections with culture or microscopy
💊 Treatment Options
🔹 Topical Treatments
- Corticosteroid creams or ointments
- Vitamin D analogs (e.g., calcipotriol)
- Tacrolimus ointment (immunomodulator)
🔹 Intralesional Therapy
- Steroid injections directly into the nail matrix (for severe cases)
🔹 Systemic Treatments (for widespread psoriasis or psoriatic arthritis)
- Methotrexate
- Cyclosporine
- Biologics (e.g., TNF inhibitors, IL-17 inhibitors)
🔹 Supportive Care
- Keep nails trimmed and clean
- Avoid trauma to nails
- Use moisturizers to reduce brittleness
🛡️ Prognosis & Impact
- Nail psoriasis can be persistent and challenging to treat
- It can significantly affect quality of life due to pain and cosmetic concerns
- Early treatment helps prevent progression and complications