Nail Psoriasis
It is common among individuals with psoriasis, with approximately 50% of people with plaque psoriasis experiencing nail changes, and up to 80% of those with psoriatic arthritis showing nail involvement.
What is Nail Psoriasis?
Nail psoriasis is a form of psoriasis that affects the fingernails and toenails, causing changes in the color, texture, and overall appearance of the nails. It is common among individuals with psoriasis, with approximately 50% of people with plaque psoriasis experiencing nail changes, and up to 80% of those with psoriatic arthritis showing nail involvement.
Symptoms of Nail Psoriasis
The symptoms of nail psoriasis can vary, but commonly include:
- Pitting: Small depressions on the surface of the nails.
- Discoloration: Nails may appear yellowish-brown.
- Thickening: Nails can become thicker and may separate from the nail bed (onycholysis).
- Crumbling: Nails can become brittle and crumble.
- Lines or ridges: Visible horizontal or vertical lines may appear on the nails.
- Red spots under the nail: Tiny spots of blood (splinter hemorrhages) may form under the nails.
How Nail Psoriasis Develops
Nail psoriasis occurs when skin cells grow too quickly under the nail, causing an accumulation of cells and leading to visible changes. Psoriasis is an autoimmune disease, and nail psoriasis is often associated with an overactive immune response. Nail psoriasis can sometimes be confused with fungal infections (onychomycosis), so accurate diagnosis by a dermatologist or a healthcare professional is crucial.
Nail Psoriasis and Psoriatic Arthritis
Nail psoriasis is often a predictor of psoriatic arthritis (PsA), a chronic inflammatory condition affecting the joints. Up to 80% of people with PsA may have nail changes, which can serve as an early indication of joint involvement. It’s essential for patients experiencing nail psoriasis and joint pain to seek medical advice to address potential PsA.
Treatment Options
Treating nail psoriasis can be challenging due to the slow growth of nails and the protective structure of the nail plate. However, several treatments are available in Australia:
1. Topical Treatments
- Corticosteroids: Topical corticosteroids can reduce inflammation and improve nail appearance. They are commonly applied to the cuticle area.
- Vitamin D analogues: Such as calcipotriol, which helps regulate skin cell production and slow down the excessive growth of nail cells.
- Tazarotene: A topical retinoid that can be used in combination with corticosteroids to improve nail changes.
2. Systemic Treatments
- Methotrexate: An immunosuppressant used in severe cases to reduce immune system activity and improve nail health.
- Biologics: Medications like adalimumab, etanercept, and secukinumab, which target specific parts of the immune system, can be effective for both skin and nail psoriasis. These medications are often used in moderate to severe cases or when psoriatic arthritis is present.
3. Phototherapy
- UV Light Therapy: Although primarily used for skin psoriasis, phototherapy may help improve nail psoriasis in some cases. Special consideration is given to targeted ultraviolet light therapy for the nails.
4. Intralesional Corticosteroid Injections
- In severe cases, corticosteroids can be injected directly into the nail bed. This treatment is typically performed by a dermatologist.
Self-care and Lifestyle Changes
Although medical treatments are essential for managing nail psoriasis, patients can also take several steps at home to care for their nails:
- Keep nails trimmed and clean: This helps reduce the risk of lifting and infection.
- Avoid nail trauma: Protect nails from injury by wearing gloves during activities that might harm the nails.
- Moisturize: Apply emollients and creams to keep nails and surrounding skin hydrated.
- Consider nail polish: In some cases, non-irritating nail polish can mask the appearance of nail changes, but avoid using harsh chemicals such as acetone-based removers.
Living with Nail Psoriasis
Nail psoriasis can significantly impact daily activities, self-esteem, and quality of life. Although it is a chronic condition, effective treatment strategies can help manage symptoms and improve nail health over time.