A certain percentage of psoriasis patients also have psoriasis of the nails. In fact 10-55 percent of those with psoriasis also have nail psoriasis and only about 5 percent of all patients with nail psoriasis are free of psoriasis of the skin. Both fingernails and toenails can be affected by psoriasis. Some patients with nail psoriasis also have psoriatic arthritis, especially involving the fingers and toes. Of those with psoriatic arthritis, up to 86 percent have nail psoriasis along with it.
Nail psoriasis is not contagious and is a hereditary condition involving the skin, joints and nails. People can be prone to psoriasis because of family history and up to 75 percent of children who have both parents with psoriasis will get psoriasis, too. There often needs to be a trigger, such as stress, trauma to the affected area, illness or immune problems that make psoriasis flare up. Both males and females are affected by nail psoriasis.
In nail psoriasis, the affected part of the skin is the nail bed, the soft tissue underneath the harder surface. When it becomes inflamed, it makes skin at an exceedingly fast rate and the fingernail can lift off the nail bed and separate away. The nails themselves can be ridged or can be pitted due to the psoriasis. The nail is discolored and looks a yellowish-reddish color that looks like a drop of oil or blood beneath the plate of the fingernail. Many feel the color is somewhat of a salmon color. Lines can develop in the nails that occur from side to side rather than the relatively normal top to bottom lines you'll see in fingernails and toenails.
You'll also see thickening of the skin beneath the nails and areas of white on the nail plate. This is referred to as leukonychia. When the top, hard covering begins to loosen it usually loosens from the tip and works its way down to the base of the fingernail or toenail. If it extends to the root of the nail, the nail will fall off. Infections, such as fungal infections of the nail bed, can occur because moisture builds up. Doctors have to treat both the fungal infection and the psoriasis to try and normalize the appearance of the fingernail.
Small black lines can run from the top to the bottom of the nail due to dilated capillaries beneath the nail itself that show up as black lines. The base of the nail fold can be reddened due to inflammation of the nail area. Many people have arthritis of the joints closest to the nails.
There is no cure for nail psoriasis but there are treatments that can make the area look better. An antifungal oral or cream-based medicine can be used to treat underlying fungal infections. You should trim your nails back short -- down to the point where the skin is attached to the plate. Be very gentle with your trimming, though, as being too rough on your nails will make them get worse.
Nail psoriasis can be treated medically or surgically. Your doctor can prescribe a steroid cream to put on and around the area to reduce inflammation. Topical vitamin A or vitamin D analogues can also be used on the nails themselves. Doctors can inject steroid medication underneath the nail itself, which works but can be very painful. Light therapy works for nail psoriasis using PUVA or UVB light. If you have psoriatic arthritis as well, the doctor can use systemic treatment with biologics or methotrexate that helps skin psoriasis, psoriatic arthritis and nail psoriasis at the same time.
If the nails are really out of control, the doctor can chemically remove them by applying an ointment that dissolves the nails within seven days with no bleeding and minimal pain. Another route to removal of the nails is to surgically remove the nails under anesthesia. The nail beds can be treated for psoriasis and after the treatment works, new and healthy tissue can be seen growing from the base of the nails.
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