Nail psoriasis normally affects several digits (fingers and toes) and is more common on the fingernails than the toenails. Pain and tenderness from nail psoriasis can impact daily activities.
Nail psoriasis may be an indicator of psoriatic arthritis (PsA), as many people have both. If you notice changes in your nails and suspect it might be nail psoriasis, visit a dermatologist to diagnose nail psoriasis and see a rheumatologist to screen for PsA.
The most common nail problems are:
- Pitting — shallow or deep holes in the nail
- Deformation — alterations in the normal shape of the nail
- Thickening of the nail
- Onycholysis — separation of the nail from the nail bed
- Discoloration — unusual nail coloration, such as yellow-brown
Nail changes may occur on the nail plate or in the nail bed or nail matrix. Where the nail is affected can determine which treatment may be most effective. Your health care provider will discuss your treatment options which may include topicals, intralesional steroids (an injection into each affected nail), phototherapy, oral treatments and biologics.
Keep nails as short as possible. Loose nails can continue to be injured if they rub against surfaces. It is important to protect your nails from damage because trauma will often trigger or worsen nail psoriasis. One easy way to do this is to wear gloves while working with your hands. 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.