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Are You Suffering From Nail Psoriasis? Dermatologist Shares 5 Unusual Signs That Shouldn't Be Ignored

Are you suffering from nail psoriasis? Look out for these warning and most unusual signs of the condition, and understand how to treat them from Dr Deepak Jakhar, Consultant Dermatologist, Dermosphere clinic.

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Written By: Satata Karmakar | Updated : September 10, 2024 11:17 AM IST

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Medically Verified By: Dr Deepak Jakhar, Consultant Dermatologist, Dermosphere clinic

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Nail Psoriasis: Dermatologist Shares 5 Unusual Signs of Nail Psoriasis And Ways To Treat Them

Nail psoriasis is a common condition that affects individuals with psoriasis, manifesting in changes to the nails that can range from mild to severe. Psoriasis typically affects the skin, but up to 50% of people with psoriasis also experience nail involvement. Nail psoriasis can impact both fingernails and toenails, leading to discomfort, cosmetic concerns, and sometimes functional limitations.

In an exclusive interaction with TheHealthSite.com, Dr Deepak Jakhar, Consultant Dermatologist, Dermosphere clinic, Joint Secretary Nail Society of India, shares more about the signs that nail psoriasis can cause and how to treat nail psoriasis from a dermatologist's perspective.

Nail Psoriasis Symptoms That Shouldn't Be Ignored

Nail psoriasis can present with a variety of symptoms, making it crucial to differentiate it from other nail disorders, such as fungal infections. Common signs of nail psoriasis include:

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  1. Pitting: Small depressions or holes on the surface of the nails are often one of the earliest signs of nail psoriasis. These pits occur due to the defective formation of the nail matrix.
  2. Nail Discoloration: Nails may develop a yellow, brown, or reddish hue, often referred to as "oil spots" due to their resemblance to an oil drop beneath the nail surface.
  3. Onycholysis: This refers to the separation of the nail from the nail bed. The nail may lift away, starting from the tip and moving toward the cuticle, leaving a gap.
  4. Thickening of the Nail: Psoriasis can cause the nail to become thicker and more brittle, a condition known as hyperkeratosis. Thick nails can sometimes be painful and difficult to manage.
  5. Crumbling or Splitting: Affected nails may become fragile and prone to breaking or splitting.
  6. Subungual Hyperkeratosis: This is the accumulation of skin cells under the nail, which can cause the nail to appear raised or uneven.

Because these symptoms can overlap with other conditions like fungal infections, it's essential to seek a dermatologist's evaluation for accurate diagnosis.

How a Dermatologist Diagnoses Nail Psoriasis

A dermatologist typically diagnoses nail psoriasis through a combination of clinical examination and medical history. Nowadays, onychoscopy is being increasingly used for diagnosing nail diseases. In some cases, the dermatologist may:

  • Perform a nail biopsy to examine a small sample of the nail tissue under a microscope.
  • Take a fungal culture to rule out fungal infections that can mimic the symptoms of nail psoriasis.

Accurate diagnosis is critical for determining the most appropriate treatment plan, as the management of nail psoriasis differs from that of other nail disorders.

Treatment Options for Nail Psoriasis

Treating nail psoriasis can be challenging, as the nails grow slowly and respond to treatment over a long period. However, several effective treatment options are available to manage symptoms and improve the appearance of the nails:

Topical Treatments

  1. Corticosteroids: These are often the first line of treatment for nail psoriasis. Corticosteroid creams or ointments can be applied to the nail matrix and cuticle to reduce inflammation and promote healthier nail growth.
  2. Vitamin D Analogues (Calcipotriol): These are sometimes used alongside corticosteroids to slow down the excessive production of skin cells that leads to nail thickening.
  3. Tazarotene: A topical retinoid, tazarotene can help with the reduction of pitting and nail thickening.

Intralesional Steroid Injections

For more severe cases of nail psoriasis, dermatologists may recommend injecting corticosteroids directly into the nail matrix. This treatment can help reduce inflammation and improve nail appearance but may require multiple sessions.

Systemic Treatments

For individuals with moderate to severe psoriasis, **systemic medications** like **methotrexate, cyclosporine, or biologics** (e.g., adalimumab, secukinumab) may be prescribed. These medications target the underlying immune response responsible for psoriasis and are often necessary when nail psoriasis is accompanied by skin or joint involvement.

Phototherapy

PUVA (psoralen plus ultraviolet A) therapy can be used to treat nail psoriasis. The nails are exposed to UVA light after being treated with psoralen, a drug that makes the skin more sensitive to light. Phototherapy can help reduce inflammation and stimulate healthier nail growth.

Nail Care and Management

Proper nail care is essential in managing nail psoriasis. Keeping nails trimmed and avoiding trauma to the nails can prevent further damage. Wearing gloves during household tasks can protect the nails from physical injury and irritation from chemicals.

Biologic Treatments

In severe cases, biologics targeting specific pathways in the immune system may be prescribed. These advanced therapies can significantly improve both skin and nail psoriasis by modulating the immune system's response.

Preventing Nail Psoriasis Flare-Ups

While nail psoriasis is a chronic condition, there are steps you can take to minimize flare-ups and protect your nails:

  • Moisturize regularly: Keeping your nails and cuticles hydrated can improve nail flexibility and reduce brittleness.
  • Avoid nail trauma: Any injury to the nails, such as biting, clipping too closely, or wearing tight shoes, can trigger or worsen psoriasis symptoms.
  • Maintain a healthy lifestyle: Managing stress and avoiding known psoriasis triggers, such as smoking, can help prevent flare-ups.

Nail psoriasis can be a distressing condition, but with proper diagnosis and treatment, its symptoms can be managed effectively. By identifying the condition early and working with a dermatologist to implement a tailored treatment plan, individuals with nail psoriasis can maintain healthier, stronger nails and reduce the impact of this condition on their daily lives.

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Satata Karmakar

Satata Karmakar

Satata Karmakar is a health journalist and Assistant News Editor at TheHealthSite.com with over a decade of experience in digital and print media. A postgraduate in Journalism and Mass Communication, she has previously worked with leading media organisations including ... Read More