Nail psoriasis is a condition that occurs when psoriasis affects the nail matrix or nail bed and leads to changes in the nail. Nail psoriasis affects approximately 90% of patients that have chronic psoriasis and is more common among adults. Nail psoriasis without associated skin psoriasis or joint disease occurs in only 5-10% of adults. Nail psoriasis can be a risk factor for developing psoriatic arthritis. Psoriasis is a systemic disease and nail psoriasis is observed when the inflammation and overgrowth of skin affects the nail bed, nail matrix, skin under the nail bed, and nail folds. Nail psoriasis presents with pitting of the nail, part of the nail turning white, red spots near the base of the nail, nail ridges or fissures, beau lines, or nail crumbling. Some other signs of nail psoriasis are if the nail surrounding the skin is inflamed or if all twenty nails are affected in some way. If necessary, your dermatologist can take a nail clipping or skin biopsy to send to a dermatopathologist for evaluation to confirm the diagnosis of nail psoriasis.
What is the treatment?
Topical medications: Topical steroids and calcineurin inhibitors can be prescribed to help reduce inflammation and ease symptoms.
Systemic treatments: Oral or injectable methotrexate and oral acitretin are two medications that can be prescribed to reduce the symptoms of nail psoriasis. Biologic injections are another systemic option to help treat psoriasis, especially for patients who also experience skin psoriasis or psoriatic arthritis. Additionally, there are new oral medications such as tofacitinib that can be used to treat psoriasis.
Phototherapy & Laser: Light and laser therapy can be used in certain cases to improve symptoms of psoriasis.
If you are experiencing symptoms of nail psoriasis, our dermatologists can evaluate your nails and work with you to develop an individualized treatment plan.
