Nail Psoriasis or Fungus?

[lovinlife]

Hello All,

Just a quick question. In the past year, I have had a chronic nail fungus in my left thumb. When it first started, I asked my derm (at a visit for my psoriasis) what it could be. She merely looked at it, said it was a fungus and prescribed me a cream (Ertaczo) to rub into my nail and cuticle. (AS if I don't have enough creams with P!) I was leary of using it because I was breastfeeding at the time. After breastfeeding and loss of half my nail, I started using the cream. It seemed to work slowly, and several months later my nail grew back with no sign of the fungus.

Unfortunately it is back and because I am trying to conceive, I can't use the cream.

But, I'm starting to wonder if this could be nail psoriasis. I'd be willing to post a picture if that would help. I have yellow and white and brown patches underneath my nail, and the nail has started to separate from the nail bed. I am in the process of finding a new derm, because I have lost all confidence and trust in mine.

btw- I have no pitting in any of my nails and all my other nails seem healthy. I also have no PA yet, so I'm hoping that this is not nail psoriasis.

[sergecosta]

Hi there lovinlife,

I have nail psoriasis, though mild, on both my big toes----and on my left thumb nail. To tell you the truth, my nail psoriasis is hardly noticeable. But I have brown spots under my nails though I never had pitting of the nails. I sometimes have a little accumulation of flakes under my nails, the three of them. I became convinced this was nail psoriasis when these brown oil spots would appear in the middle of my nail and resolve. Right now, the nail psoriasis is confined to the distal parts of my three nails which makes it easy for me to apply Protopic under the nail edge. It seems to work well. However, I have seen my left ring finger's nail resolve on its own many times. It comes and goes although the nail psoriasis on my big toes have pretty much persisted for several years now. They're definitely not as yellow as they used to be, but the brown areas do linger.

The best thing that works for me: don't mess with it too much (be careful when cleaning your nails). It's better to soak with the lukewarm water (not hot) and just let the scale loosen if you have any. I wouldn't even try to scrape it off. Protopic under the nail not only moistens the flaking but seems to really resolve the brown oil spots near the distal edge.

Best of luck
Sergio

[GitOverIt]

Trying to get PG! congrats! much success!

Dr. Heng told me to use LOTRIMIN CREAM 1% (OTC) it's the (jock itch cream too) mix it with equal parts of Hydrocortisone 1% cream and apply to fungus area... I took the whole tube of Lotrimin and emptied into a clean glass corning ware (with lid) then added and measured by eye, equal amounts of hydro...stirred with a toothpick...Keep hands out of mixture as not to contaminate the mix and re-infect.......
I used this for inverse P under boobs, arm pits, groin area etc wherever fungus might be.....It might work for nails? not sure but it sure helped me.
So I looked it up for safety sake and this is what I came up with...but use your own judgement! since no one ever really knows about or will say when PG is involved!


http://72.14.205.104/search?q=cache:HG-USFnwFnkJ:www.nlm.nih.gov/medlineplus/druginfo/uspdi/202155.html+Lotrimin+OTC+pregnancy+side+effects&hl=en&gl=us&ct=clnk&cd=3&ie=UTF-8

[evergreen]

Hey lovinlife! That sounds like nail P to me... :(

[4Given]

I have had small pitting in my nails for years. Then when PA really decided to show up I began noticing the "brown dots" under my nails. It started on my left index finger then my right index finger. Then slowly my left index fingernail began to lift up from the fingertip. After it began to rise noticibly it began to hurt like @%#. Then the same thing on the right index finger. After a few months of this the pustular blisters began to arise on both of the index fingers from the tip back.

Several derms and several diagnosis later, even being told I had a wart growing under my fingernail, I found my rheumatologist who immediately knew what was going on. After the bloodwork, xrays, history, and visible psoriasis he diagnosed the psoriatic arthritis. He prescribed methotrexate and sulfasalazine. After several weeks of the mtx the nails began to clear and the inflamation left my fingernails.

I turned out to be deathly allergic to the sulfasalazine though and aquired Stevens Johnson Syndrome from it. If you do not know what SJS is you need to research it. Anyone with kids should know about SJS. Anyone who is on medications such as the ones we psoriasis and psoriatic arthritis sufferers take should also know about it.

Look up the Stevens Johnson Foundation website!

[lovinlife]

Thanks everybody. I did meet someone at work yesterday who has psoriasis. She has it in her nails with PA too. On Enbrel and loving it. Anyway, she took one look at my nail and said she was confident it was psoriasis.
And from the descriptions you guys provided, mine sounds the same. Brown spots, white spots, yellow discoloration, and separation of the nail from the bed. So, I wonder if I will get PA? Does everybody with nail P, get PA? Is one kind of nail P more likely to have PA symptoms? Guess I'll just try to take one day at a time and think positively.

The only thing I am confused about still is if I have a secondary fungal infection because of the nail P. Sounds like that could be the case?

[jbrickman]

as you describe it - it sounds like nail psoriasis. mine is sensitive to pressure - is yours?

[Lee140]

It was my nails that led my rheumie to suspect PA. She was working w/Ankylosing Spondylitis until she looked at my feet and starting searching my entire body for P. She found what she thinks is P behind both ears. Mine started w/my toe nails, but within the last 2 months seems to be hitting the finger nails too. Both thumbs and index fingers have turned yellow and have dents or maybe they're pits. I have suddenly developed raised vertical ridges on all my toe and finger nails. I also have side to side indentations on all my toe nails. They look like rings on a tree. Both big toe nails have what may be the brown spot some of you described. They are completely yellow from the top to a third down, but have an area that looks more reddish brown. It's not really dark, it's pretty subtle. I have what looks like dry skin scales that sometimes grow on the nail that I can scrape off. Underneath the nail it looks a little pushed up, red and looks like there's dry skin built up under the tip. I noticed that when I trim them, that the white part seems to go too far down. Does anyone know what I mean by this? Does this mean the nails are lifting up? If I trim all the white off I take 1/3 of my whole nail off with it!

I've also wondered if there's also a nail fungus going on w/the P. I apologize for what I'm about to describe for those that are weak of stomach. When I tried to "clean up" my big toes I scraped out along the sides what looked like white powder. I don't know if this is pulverized skin cells or a fungus. If anyone has any info on this, I'd greatly appreciate it. For the time being, I've "quarantined" the clippers from the rest of the family until I see the derm next week.

Lovinlife, I hope you don't develop PA along w/P. I don't remember the exact statistics of those w/Nail P that develop PA, but I'm pretty sure I saw them on this website. If not, I think the Mayo Clinic website has them. If it's any help, I have a friend that's had P and Nail P for over 20 years and she doesn't have PA. My rheumie told me that there's a connection between how much pitting you have and developing PA and how aggressive it will be. She's at the Cleveland Clinic and seems to really know her stuff. So it's good you don't have the pits!!

Lee

[sergecosta]

Hi Lee!

Nail fungus can certainly overlap with nail psoriasis. All that extra keratin is like a banquet for the dermatophytes that lead to fungal infections of the skin and nails.

I used to trim my big toe nails just as you say -- until a third is gone. And I used to put medication afterwards to control the psoriasis. It might strike you as odd, but the less I did with my nails the better it turned out. The yellow discoloration was the worst. None of my nails have it now even though the nail psoriasis persists. So I deal with mild accumulation of skin underneath the nails' free edge and some reddish-brown areas which are precisely as your describe it, very subtle. One other thing that I have noticed with these oil spots, as dermatologists call them, is that within a spot there are several micro-spots that are darker: a small lake with little boats on it, sometimes half dozen or more, to offer an analogy here.

I now use Protopic for the distal areas of the nails where I have nail psoriasis and it seems to be working very well.

So best of luck to you
Serge

[lovinlife]

as you describe it - it sounds like nail psoriasis. mine is sensitive to pressure - is yours?

Yes sensitive to pressure. My thumb is sort of hot and also sensitive right by the cuticle if that makes sense. Maybe I also have a secondary bacterial infection too? Or maybe that is from fungal toxins? Or maybe it is just the P. Who knows!?

[Lee140]

Thanks, Serge! I do usually try and leave them alone, but I had emergency circumstances. My mother is coming from Michigan to help out this weekend. She suggested I go and have a pedicure and manicure on her. Very sweet, but no way am I walkin' these dogs into a salon. She then said she'll bring her massaging foot spa and give me a pedicure herself (I love my mom!). Still, it took some serious work today to get them into shape even for that!!

To make it worse, my PA is in my lower back. Just to get a close look at what's going on there still has me saying ow...oww..owwwww!!!

Lee

[kimie]

Lovinlife - I know the feeling! But it sounds like nail P to me. And maybe fungus too???

I have the nail P, and have had it for quite awhile now. While it is not too extreme on my hands right now (I have had it worse at times) - just the "oil pits" or "stains" and top of the nail separation from the beds - my little piggies have it the worst! :o All ten toes in one from or another, with the big toes suffering the worst. While I have learned to live with ugly toes, it's the ingrown toenails on those two that drive me bonkers! :eek: Always, always, always get them. But I'm wondering if that is in the genes or a effect from nail P....

I do have some pitting on me fingies. Another reason why I'm finally getting to a rheumy. :) But, for the most part of my life with P, the nail aspect never really bothered me all that much. The only issue I have is when they get mishappened/shaped and get hung up on every little thing! :mad: Like Lee, I don't do much (for me, anything) other than keep them trimmed down...

[Lee140]

Lovinlife- I know EXACTLY what you mean by sensitive around the cuticle. Sometimes it even hurts to bend my thumbs. At first I thought it was the joint in my thumb, but it's not. It's actually the cuticle. When it really flares up it can be difficult to button my pants. When the inflammation in the cuticle goes down, they no longer look red, but just have an almost light brown/tan discoloration all the time. I've always had great nails and no trouble w/my cuticles before this.

Kimie- Sounds like you have my toes! All ten toes affected in some way or another and big toes taking the brunt of it for the other little piggies! Fingernails right now just w/light pitting. Although in the last month they've started to yellow, thicken slightly and have become brittle. The raised vertical ridges and a single indentation running side to side across each fingernail seemed to come out of nowhere.

One more thing for anyone with the side to side indentations running across your nails. My rheumie said they are called Beau's Lines and are an indication of inflammation.

Lee

[lovinlife]

Lee- Yep, that is exactly what I have too!

Kimie- I was just reading your thread on PA. I'm learning so much on this site, and I'm much happier being aware of my symptoms etc... Besides my thumb acting up, last month I started having pain in my left foot. Right in the middle of my arch if that makes sense. For 3 weeks when I would wake up from bed and stand on my foot, the pain was unbearable. I would limp for the first hour after waking. The pain would subside during the day, but come back if I sat for too long. I couldn't remember injuring my foot, so it was really perplexing. Now the pain is gone.

I've decided that I'm starting a pain and symptoms diary. It might come in handy in the future.

[jbrickman]

Yes sensitive to pressure. My thumb is sort of hot and also sensitive right by the cuticle if that makes sense. Maybe I also have a secondary bacterial infection too? Or maybe that is from fungal toxins? Or maybe it is just the P. Who knows!?p - vexing as always. i hope you find something that works out for you :) .

[NPFLaura]

Count me in as being part of the ugly toes club. I have issues with the fingers too for that matter. I had gotten a pretty bad fungal infection under my finger nail and was told by the dermatologist - no artificial nails. Another coincidence is that I used to get terrible ingrown toe nails when on enbrel. The first one was the worst as I didn't take it seriously and the infection almost reached the bone. I think that having nail psoriasis just makes us more susceptible for other nail issues and infections. On a side note, I often get fungal infections pretty regularly too - armpit, groin, stomach. What fun.

[mildred1975]

I have nail psoriasis and I also thought it was fungus, although I wish it was rather than nail psoriasis. I usually cover them with finger nail polish. I have not found anything that works for nail psoriasis, also keep it short, and avoid any acrilics they tend to lift the nail more from the nail bed.

mildred

[NPFLaura]

Hi, I found something that helps my finger nails on QVC: T.I.P.S. 5 Piece Nail Conditioning Kit - item #A65218. There are several kits you can order - some w/ nailpolish remover, files, etc. I like the solution only option. My nails where splitting and I bought TIPS and saw great improvement when I used it a few times a day. Aside from the splitting, I hadn't expected to help under the nail, reducing the seperation and psoriasis. When I didn't keep up with it, the spliting returned. Good news - men can be comfortable using it too. It's clear and it's not polish-like. The shine you get is eventually just healthy nail. There is no need for nailpolish remover - it's truly a conditioner. I haven't really tried it for long on the toes to see if I can fix those nails too, though TIPS sells something for the toes which I hadn't tried. They sell polish which I haven't tried either.

[hotkoko808]

well sort of, none of us with P are lucky. all ten of my toes are affected, my big toes have completely crumbled off twice in the last year, and the rest have grown really thick and have become wider and really short. on my hands my pinky nail which was the first of all my nails to show signs has gone thru cycles of crumbling off. Right now its thick, really bumpy, red and it made my whole finger look deformed. My middle finger nail is brownish red and it's starting to grow it "second" nail from underneath. This sucks big time. until 2 1/2 yrs ago i was going to the salon with my friends twice a month, you couldnt pay me to go near one now. I wish i lived somewhere cold so i could wear gloves =( hope something works to keep you nails at bay. I have tried everything.

[evergreen]

Hey lovinlife! Instead of a secondary fungus, perhaps the P is in the nail, not just under it...

I believe that nail P leads to PA, I would suggest getting on something to curb that from happening, something like Humira and/or MTX. I think if you can be proactive that it may be beneficial to your joints...

Take care~
evergreen