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Managing nail psoriasis

Nail psoriasis: Where the nail is affected determines where treatment is applied If you have psoriasis and have experienced any abnormalities in your nails, such as pitting, discoloration, crumbling, loosening, thickening or horizontal lines, you might have nail psoriasis.

Up to 55 percent of people with skin psoriasis also have nail psoriasis, or psoriatic nail disease, according to medical experts. About 5 percent of people with nail psoriasis do not have skin psoriasis. For people who have psoriatic arthritis, up to 86 percent also have nail psoriasis.

Todd Bellow, 48, of Stonybrook, N.Y., started to notice pitting and drying on his left big toenail about two years ago. He had never had trouble with his nails in more than 26 years of living with severe psoriasis. Before long, his fingernails started to show pitting, too.

"Believe me, people are less likely to shake your hand if they see your diseased fingernails," Bellow says, explaining that this makes him self-conscious, producing a "vicious cycle" of self-consciousness.

Where the nail is affected determines where treatment is applied, according to Dr. Mark Lebwohl, professor and chairman of The Mount Sinai School of Medicine dermatology department in New York and chairman of the National Psoriasis Foundation Medical Board. Pitting of the nail occurs in the nail matrix, the base of the nail where the nail is produced, while thickening of the nail occurs in the nail bed, the skin underneath the nail.

For people with mild symptoms, topical treatments or steroid injections at the site paired with cosmetic treatments can help, Lebwohl says. Cosmetic treatments include keeping nails clipped short, buffed smooth and painted with clear polish. For people who also have severe skin psoriasis and/or psoriatic arthritis, a systemic or biologic treatment can reduce symptoms overall. Nail improvement may lag behind clearing of psoriasis plaques on the body by several months. It can take six months to a year for an affected nail to grow out and be replaced by a new nail.

After developing problems with his nails, Bellow started having pain in his ankles and other joints and was diagnosed with psoriatic arthritis. Consulting with his doctor, he decided to try biologic injections. Since then, his skin and nails have begun looking much better and his joint pain has stabilized. "I'd do almost anything to overcome this," he says.

Lebwohl says that regular manicures done by a nail technician familiar with nail psoriasis or at home can dramatically improve the appearance of nails affected by psoriasis. Care should be taken to treat the affected nails gently and cuticles should not be clipped or pushed back. If a nail is lifting, avoid overly aggressive cleaning under the nail tip, which can make lifting worse. Gentle buffing with a file can help smooth the surface. Finish with clear polish.

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