Causes of Nail Psoriasis
Usually, nail psoriasis occurs in patients with psoriasis. It is associated with Psoriatic arthritis (arthritis in fingers and toes), occurring in about 50-85% of these patients.
Signs and Symptoms of Nail Psoriasis
Nail psoriasis may affect the nail plate, nail bed (the tissue under the nail), nail matrix (the tissue from which the nail grows), nail folds, cuticle, and the bones at the end of the fingers. Signs of nail psoriasis vary according to the part of the nail affected and the nature of the deformity.
It is rare that a person develops psoriasis only on the nails and nowhere else on the body. There are five general types of Nail psoriasis; these changes may occur alone or simultaneously. They include:
Pitting: A deeply pitted nail caused by the deficiencies in nail growth due to psoriasis in the nail matrix, characterized by loss of parakeratotic cells from surface of nail plate.
Discoloration of the nail bed (yellow or yellowish pink) resembling drops of oil under the nail plate, referred to as an “oil drop” or “salmon patch” caused by psoriasis in the nail bed.
The appearance of a white area separating and lifting from the nail plate, caused by pockets of air where the nail bed is lifting from the nail bed. This is referred onycholysis, and may be accompanied by inflamed skin around the nail.
Crumbling and total loss of the nail due to psoriasis causing weakening of the nail matrix.
Psoriasis of the finger and toenails can resemble other conditions such as chronic fungal infection or inflammation of the nail bed.
Nail Psoriasis Treatment Options
Your treatment will depend on the type of nail psoriasis you have and how severe it is. If you have psoriasis that affects other parts of your body, the treatments your doctor recommends to alleviate those symptoms may also help your nail psoriasis. Other options for nail psoriasis include:
Topical treatments. These medications are applied to the nails:
Dovonex (calcipotriene), a form of synthetic vitamin D3 that can slow cell growth
High-potency corticosteroids, anti-inflammatory medications that can be applied to the nails temporarily
Cordran (flurandrenolide), a steroid medication that is in the form of a tape that can be applied to the nails
5-fluroruracil cream, a topical treatment that often helps with nail pitting
Tazorac (tazarotene), a topical medication that can slow cell growth
Corticosteroid injections. In some cases, having steroid medications injected into your nail bed or matrix can temporarily improve nail psoriasis symptoms.
Phototherapy. A type of phototherapy known as PUVA (psoralen and ultraviolet light A) uses UVA light plus a light-sensitizing medication called psoralen. When your skin or nails are sensitized to UVA rays, excessive cell production can be slowed. PUVA for nail psoriasis may involve taking psoralen orally or painting it onto the nails before UVA treatment.
Cosmetic nail repair. Sometimes surgery or the application of a urea compound is necessary to remove deformed nails. In cases where nails are excessively thick and long, they can be filed down. If nails are discolored or otherwise cosmetically deformed, the deformity can be covered up with nail polish or artificial nails. And pitted nails can be buffed and polished.
