Managing nail psoriasis

Nail psoriasis: Where the nail is affected determines where treatment is applied If you live with psoriasis and have experienced any abnormalities in your nails, you might have nail psoriasis.

Up to 35 percent of people with  psoriasis and up to 86 percent of those with psoriatic arthritis also have nail psoriasis. The most common nail issues include:

  • Pitting - shallow or deep holes in the nail
  • Deformation - changes to the normal shape of the nail
  • Thickening of the nail
  • Onycholysis [ahn-uh-KAHL-uh-suhs] - separation of the nail from the nail bed
  • Discoloration -  unusual nail coloration, such as yellow-brown, that may look like a fungal infection

Where the nail is affected determines where treatment is applied. 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. 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. Nail improvement may lag behind clearing of psoriasis plaques on the body by several months and it can take six months to a year for an affected nail to grow out and be replaced by a new nail.

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. 

Get the facts on nail psoriasis

Connect with the NPF Patient Navigation Center for advice on treatment of nail psoriasis, along with finding the right health care professional to help you. Contact a patient navigator today. 

Last updated on  by the National Psoriasis Foundation