Nail Psoriasis: Causes and Symptoms

Nail psoriasis is a condition where the skin disorder psoriasis affects the nails, causing changes in the nail bed. Psoriasis, a chronic autoimmune disease, causes the skin cells to multiply rapidly, resulting in scaly patches. In the case of nail psoriasis, it can lead to various nail issues such as pitting, discoloration, thickening, or even the separation of the nail from the nail bed. This disorder can be extremely painful and may cause discomfort by interfering with the nails' normal functions. Both fingernails and toenails may be impacted.

Although nail psoriasis is not fatal in and of itself, it can significantly impair quality of life and cause great suffering. In severe cases, it may even lead to permanent nail damage. Treatment typically involves topical therapies, oral medications, or phototherapy, based on the severity of the condition.

Types of Nail Psoriasis

A variety of nail psoriasis kinds exist, each with unique characteristics. These are the primary kinds:

Pitting: This form is the most prevalent and is characterized by tiny, shallow pits or depressions that resemble thimbles on the surface of the nails.
Onycholysis: This type is uncomfortable and increases the risk of infection because the nail begins to lift or separate from the nail bed.
Hyperkeratosis: Here, the nail becomes thickened and develops a rough texture due to the accumulation of dead skin cells.
Subungual Nail Involvement: This involves a build-up of skin beneath the nail, leading to discoloration and sometimes the formation of yellowish or brown spots underneath the nail.
Nail discoloration: The nails may become reddish or yellow-brown, and this condition is frequently accompanied by additional symptoms including thickness or pitting.
Crumbly Nails: These nails are hard to keep up with since they become brittle, delicate, and prone to breaking or crumbling.

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What are the Symptoms of Nail Psoriasis?

The Nail psoriasis symptoms can differ from person to person, but the common signs usually include:

Pitting: Small, shallow depressions or pits appear on the surface of the nails, which is one of the most frequent signs of nail psoriasis.
Nail Discoloration: Nails may develop yellow, brown, or reddish spots, or even a discoloration beneath the surface of the nails.
Thickening of Nails: The nails may become thicker and may feel rough or uneven, leading to discomfort.
Onycholysis: This is when the nail starts to separate from the nail bed, causing pain and increasing the risk of infection.
Crumbly or Brittle Nails: The nails can become fragile, break easily, or crumble, which makes them difficult to manage.
Pain and Sensitivity: In some cases, the nails may become tender or painful, especially if there's lifting or thickening.
Nail Folds: The skin around the nails may become red or inflamed, leading to swelling in the nail folds, which is where the skin meets the nail.

In some cases, the oil drop sign in psoriasis may appear, where a yellowish-brown discoloration forms under the nail, giving the appearance of an oil drop. This is another distinctive symptom of nail psoriasis. These symptoms can vary in intensity and may affect both fingernails and toenails, worsening over time if not treated.

What are the Causes of Nail Psoriasis?

The Nail psoriasis causes are not fully understood, but there are several factors that contribute to the development of this condition. These include:

Genetics: Psoriasis of the nails is frequently inherited. You have a higher chance of getting psoriasis if someone in your family already has it. Its occurrence is significantly influenced by genetics.
Immune System Dysfunction: Psoriasis is an autoimmune disease in which healthy skin cells are mistakenly attacked by the immune system, leading to a high rate of cell turnover. The nails may also be impacted by this.
Illnesses: Psoriasis can be brought on by or made worse by certain illnesses, such as throat infections. It is thought that infections may trigger an overreaction by the immune system, resulting in nail psoriasis.
Trauma or Injury to the Nails: Physical damage to the nails or nail beds can trigger the onset of psoriasis. This is known as the Koebner phenomenon, where psoriasis develops at sites of skin injury.
Stress: Emotional or physical stress can worsen psoriasis symptoms, including nail psoriasis. Stress can trigger flare-ups or make existing symptoms more severe.
Medications: Certain medications, like those used to treat high blood pressure or heart disease, can trigger or worsen psoriasis in some individuals.
Weather: Cold, dry weather can trigger psoriasis flare-ups, including on the nails, due to dry skin and less exposure to sunlight.
Hormonal Changes: Hormonal changes, particularly during puberty or menopause, can also influence the onset or worsening of nail psoriasis.

Diagnosis of Nail Psoriasis

A physical examination, medical history, and occasionally other tests are used to diagnose nail psoriasis. It is usually diagnosed as follows:

Physical Assessment: Common symptoms of nail psoriasis, like pitting, discolouration, thickness, or separation from the nail bed, will be checked for by the physician. They will also look for further skin or scalp psoriasis symptoms.
Medical History: The doctor will ask about your family history of psoriasis, your personal medical history, and any triggers or patterns of the condition. They may also inquire if you’ve had any recent trauma to the nails or infections that could have triggered the condition.
Biopsy: In some cases, the doctor may take a small sample of the affected nail tissue for a biopsy. This procedure helps to confirm the diagnosis and rule out other conditions that might have similar symptoms, such as fungal infections.
Wood's Lamp Examination: This technique uses a special ultraviolet light (Wood's lamp) to examine the nails. It can help identify fungal infections or other nail disorders that might be mistaken for nail psoriasis.
Nail Scraping or Culture: If there’s a suspicion of a fungal infection, a sample of the nail may be scraped and sent for a culture test to check for fungal growth. This helps to differentiate nail psoriasis from a fungal infection.
Blood Tests: Though not always necessary, blood tests may be conducted to rule out other conditions that could cause similar symptoms, such as infections or autoimmune disorders.

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What are the Treatment Options for Nail Psoriasis?

Nail psoriasis is a long-term condition where psoriasis affects the nails, leading to symptoms such as discoloration, pitting, thickening, and sometimes, nail detachment. Treatment for nail psoriasis is focused on managing the symptoms and preventing further damage to the nails.

Here are the main nail psoriasis treatment options:

Topical Treatments: The first line of nail psoriasis treatment usually includes corticosteroids, vitamin D analogs, and topical retinoids. These are commonly found in nail psoriasis treatment creams that help reduce inflammation and manage skin changes.
Systemic Medications: For more severe cases, oral medications like methotrexate, cyclosporine, or acitretin may be prescribed. These nail psoriasis medications work by reducing inflammation and regulating immune system activity.
Biologic Therapy: For severe nail psoriasis, biologic drugs can be effective. These medications target specific parts of the immune system and are usually administered via injection.
Phototherapy: Ultraviolet (UV) light therapy, combined with topical treatments, can be helpful in treating nail psoriasis, particularly when it involves the nails.
Nail Care and Surgery: Proper nail care, like avoiding trauma and keeping nails clean, can prevent worsening of the condition. In severe cases, surgical intervention might be needed to remove damaged nails.
Laser Treatment: Laser therapy is another option for nail psoriasis, where focused light targets the affected areas, helping in the treatment process.

How to Prevent Nail Psoriasis?

Preventing nail psoriasis can be a bit difficult since it is a genetic and immune system-related condition. However, there are certain steps you can take to manage and reduce flare-ups, preventing further nail damage.

Here are some tips to prevent nail psoriasis:

Avoid Nail Trauma: Injury or trauma to the nails can trigger flare-ups. So, be careful when handling sharp objects, and avoid harsh manicure or pedicure practices.
Keep Nails Moisturized: Dry nails can worsen psoriasis. Make it a habit to apply a moisturizing cream or oil to your nails and surrounding skin regularly to keep them hydrated.
Protect Nails from Chemicals: Harsh chemicals in cleaning products can irritate the nails and skin. Always wear gloves while using these products to protect your nails.
Manage Stress: Emotional stress can trigger flare-ups in psoriasis. Try practicing relaxation techniques like yoga, meditation, or deep breathing exercises to keep stress levels under control.
Healthy Diet: A balanced diet that includes anti-inflammatory foods like omega-3 fatty acids, fruits, and vegetables can help manage psoriasis. Avoid foods that may cause inflammation.
Regular Follow-up with a Dermatologist: Early treatment and consistent check-ups with a dermatologist can help manage the condition and reduce its severity.
Use Nail Psoriasis Treatment Creams: Regular use of prescribed nail psoriasis treatment creams can help prevent worsening by controlling inflammation and promoting healthy nail growth.

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Frequently Asked Questions

Is nail psoriasis harmful?

Nail psoriasis itself is not life-threatening but can cause nail damage, discomfort, and cosmetic concerns.

What deficiency causes nail psoriasis?

There is no specific deficiency linked to nail psoriasis, but low levels of vitamin D, zinc, or biotin may worsen the condition.

What is the difference between nail fungus and nail psoriasis?

Nail fungus usually causes thickening, discoloration, and a crumbly texture, while nail psoriasis leads to pitting, discoloration, and separation of the nail from the nail bed.