Nail Psoriasis

Causes of Nail Psoriasis

Psoriasis is not contagious. How psoriasis of the nails develops is not completely known. It appears to
result from a combination of genetic (inherited), immunologic, and environmental factors.
Psoriasis tends to run in families. If you have a parent or a sibling who has psoriasis, you have a
16%-25% chance of having psoriasis, too. If both of your parents have psoriasis, your risk is 75%.
Males and females are equally likely to have psoriasis. Psoriasis can occur in people of all races.
Nail Psoriasis Symptoms
Usually, if psoriasis affects your nails, you have skin symptoms, too. If you have psoriasis of the nails
but do not have skin symptoms, the condition may be difficult for your doctor to diagnose. Inform your
doctor if you have a family history of psoriasis.
Your nail area is made up of a nail plate, nail bed, hyponychium, nail matrix, nail folds, cuticle,
anchoring portion, and ends of the finger bones. You can see each of these structures in images 1-2.
If you have psoriasis of the nails, you might notice the following signs:
Clear yellow-red nail discoloring that looks like a drop of blood or
oil under the nail plate: Your doctor may refer to this as an oil drop or a
salmon patch. This is a sign you have nail psoriasis.
Little pits in your nails: A doctor may call this pitting of the nail matrix.
Pits develop when cells are lost from the nail's surface.
Lines going across the nails (side to side rather than root to tip):
These are also called Beau lines of the nail. Cells respond to psoriasis by
becoming inflamed from time to time, which causes these lines.
Areas of white on your nail plate: Also called leukonychia or midmatrix
disease. It is also caused by a reaction of your cells to psoriasis.
Thickening of the skin under your nail: The doctor may call this
subungual hyperkeratosis. This can lead to loosening of the nail.
Loosening of the nail: Also referred to as onycholysis of the nail bed
and nail hyponychium. Your nail may develop a white area where it is
separated from the skin underneath your nail. It usually starts at the tip of
the nail and extends toward the root. The nail bed (skin under your nail)
may become infected.
Crumbling of the nail: The condition is also called nail plate crumbling
at the nail bed or nail matrix. The nail weakens because the underlying
structures are not healthy.
Tiny vertical black lines in the nail: Your doctor may call this a splinter
hemorrhage or dilated tortuous capillaries in the dermal papillae. This
occurs when the tiny capillaries in the tip of your fingers bleed between
the nail and the skin under the nail.
Redness of the pale arched area at the bottom of your nail: Also
called spotted lunula. It occurs when the capillaries under the nail are
congested.
Arthritis of your fingers with nail changes: The nails are affected in
53%-86% of people who have psoriatic arthritis.
Nail psoriasis can also occur together with fungal infections of the nail (onychomycosis) and
inflammation of the skin around the edges of your nail (paronychia).
When to Seek Medical Care for Nail Problems
If you notice changes in your nails such as discoloration (white spots or yellowing areas) or pits or if
your nails seem infected or are painful, see your doctor.
Exams and Tests for Nail Psoriasis
Your doctor may take a biopsy (a small sample) of the skin under your nail to determine if you have
psoriasis of the nail.
Nail Psoriasis Treatment
At present, psoriasis of the nails does not have a cure. The goal of treatment is to improve the
function and appearance of your nails. If your nails have a fungal infection, your doctor will prescribe
an antifungal medication.
Home Remedies for Nail Psoriasis
In areas where your nail has loosened, gently trim the nail back to the skin where it is connected. This
will allow medications to work better. All nail care must be very gentle. Vigorous nail care can cause
psoriasis to flare. Attempt to avoid injuring nails so they don't loosen more or become infected.

Medical Treatment for Nail Psoriasis
Your doctor may recommend that part of your nail be removed, either chemically or surgically.
Chemical removal of your nail involves putting an ointment on your nails for seven days. The nail
comes off by itself with no bleeding.
Medications for Nail Psoriasis
Your doctor may prescribe any of the following medications for nail psoriasis:
Creams or ointments to rub on and around the nail, including steroid,
topical vitamin A or D derivatives, or, occasionally, antifungal solutions
may be needed if a fungus infection is present. However, delivery of
medications to the nail area is difficult because of the barrier presented
by the nail plate. Topical treatments (applied directly to the nail) may not
be effective in all cases.
Steroids applied to the skin under your nail or injected under the nail
PUVA (This therapy is a combination of the prescription drug psoralen
and exposure to ultraviolet light.)
Systemic therapy if you have both skin and arthritis symptoms (systemic
therapy is medication that spreads throughout your body). It is often in pill
or injectable form, including methotrexate tablets, and injectable Enbrel
(etanercept), Humira (adalimumab), as well as infusible Remicade
(infliximab).
Surgery for Nail Psoriasis
If other treatments don't work, a doctor can surgically remove the nail. The area is numbed with a
local anesthetic before the nail is removed.
Preventing Nail Psoriasis
To prevent psoriasis of the nails, keep your nails dry and protect them from damage.
Nail Psoriasis Outlook
Nail psoriasis does not have a cure, but the treatments mentioned above may improve the
appearance and function of your nails.
Multimedia
Media file 1: Anatomy of the nail, view from top.

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Media file 2: Anatomy of the nail, side view.

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Media file 3: Nail psoriasis with nail loosening. Image courtesy of Hon Pak, MD.

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Media file 4: Nail psoriasis of the fingernails and toenails. Note discoloration. Image courtesy of Hon
Pak, MD.


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Media file 5: Nail psoriasis with pitting. Image courtesy of Hon Pak, MD.

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Media file 6: Nail psoriasis with joint involvement.

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Media file 7: Extensive psoriasis with nail and joint involvement.

Media type: Photo