Nail Psoriasis

[JustSuzy]

Nail Psoriasis

Many people who have psoriasis also experience changes in their fingernails or toenails. There are several treatments that can help.

By Krisha McCoy, MS
Medically reviewed by Kevin O. Hwang, MD, MPH

Nail psoriasis is the term for the changes in your fingernails and toenails that occur as a result of having psoriasis. Up to half of all people who have psoriasis will have nail psoriasis as well. Whileit's not a life-threatening condition, nail psoriasis can affect your quality of life, since it may cause you discomfort and affect your self-esteem, and it may also put you at greater risk of developing psoriatic arthritis. Although it cannot be cured, nail psoriasis can be helped with treatment.

How Psoriasis Affects the Nails

Nail psoriasis occurs because psoriasis affects the process of nail formation. People who have nail psoriasis usually have psoriasis on other parts of their body, such as the skin and joints. Rarely does someone have only psoriasis of the nails.

Symptoms of nail psoriasis vary but may include:
Discoloration of the nail to yellow-brown
Pitting (holes) in the surface of the nails
Horizontal lines across the nails
White patches on the nails
Thickening of the nails
Nails that separate from 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.

Keeping Nails With Psoriasis in Good Shape

In addition to following your doctor's recommendations involving treatment for nail psoriasis, there are other ways to take care of your nails:
Keep your nails trimmed as short as possible.
Wear gloves when you're working with your hands.
Wear shoes with plenty of room in them.
Avoid scrubbing or scraping underneath your nails.
Use gentle nail-cleaning tools.
Soak your nails in tar bath oil mixed with water, then apply nail moisturizer.
If your nails are intact, consider using a nail hardener to improve their appearance.

Taking good care of your nails can minimize the effects of psoriasis-associated nail changes

[Fred]

Thanks Suzy, Nails are good indicator of your health, here is a thread we had on the old forum.

There are a range of colours in nails that may denote health problems. They ought not be ignored. Here are some of the more common ones:

* Bluish/deep blue nail beds - heart or respiratory problems/pulmonaryobstruction/asthma/emphysema
* Dark blue line in nail - can be sign of skin cancer
* White/pale/lacking lustre - can indicate anaemia/lack of vitality or liver/kidney disorders
* White/waxy – may mean internal bleeding or worm infestation
* White nails with pink near tips – may be sign of cirrhosis
* White/crumbly – often fungal infection
* Nail half white/dark spots on tips – possible kidney disease
* Yellow – may be the first warning of major illness, eg respiratory, liver, lymphatic systems/diabetes/cancers. Can also be found in any condition that causes nail growth to slow down
* Yellow and thick—common in smokers/ possible fungus/ potential pulmonary disease.
* Pink half moons – may signify candida infection
* Light red left index fingernail - may mean high blood pressure
* Light red or purplish – may indicate prostate problems
* Dark nails – vitamin B 12 deficiency/anaemia
* Brown strips in upper third of nail (or whole of upper nail goes brown) when kidneys are damaged.
* Greenish nails – sign of infection
* Greyish nail roots – chlorine deficiency
* Irregular red lines at base of the nail fold - possible lupus or connective tissue disease
* Dark line or streak under the nail - always have checked for melanoma (especially if under nail of thumb or big toe)
* Tiny black streaks – can mean heart disease
* Reddish, brown spots – deficiencies (folic acid, vitamin C, protein)
* Opaque nails with dark band at top – can be simply ageing but check for more serious conditions (heart/liveer/diabetes/cancer)

Spots/Ridges/Lines/Pitting

Marks on nails can also be important signs of a health problem. Here are a few to look out for:

* Small white spots under nails – deficiency zinc or calcium/worms/chronic constipation/fatigue/ virus in adolescence/fasting
* Single horizontal white line – lead/arsenic poisoning
* White lines across nail may denote liver disease/heart disease/fever
* Horizontal ridges - may indicate stress or be a sign of the flu/other infections/gastrointestinal troubles.
* Vertical ridges are common in many conditions eg fibromyalgia/calcium deficiency/anaemia/digestive weakness/kidney problems/parasites. They are also more common in ageing and those with tendency to arthritis
* Vertical black lines at the top of the thumbnail may indicate heavy metal toxicity.
* Pitting – psoriasis/psoriatic arthritis/dermatitis/or associated with alopecia (hair loss)

Grooves and Moons

Grooves in nails and moons (crescents or arcs at base of nail) also give us clues to overall health:

* Horizontal grooves/dips – present after recent physical or emotional health problem/parasites (see also depression in nails)
* Groove in index fingernail – may mean tendency towards skin disease
* Groove in ring fingernail – possible eye problems
* Groove in middle fingernail – loss of muscle strength
* Well shaped moons – indicate good health/good cardiovascular function
* Unusually large or asymmetrical moons – possible high blood pressure
* Lack of moons – may mean problems with nervous system
* Small/obscured moons – asthma/gout/respiratory or gastrointestinal problems
* Low moons on thumbs – may not be absorbing minerals
* Moons are often obscured after a stroke
* Red moons – can indicate heart problems
* Slate blue moons – overexposure to silver/or lung problems
* Should have moons on all except little fingers. If on little ones, check for heart disease

Shapes and Other Nail Conditions

All of these are important to look out for, as often early signs of health problems:

* Flat nails– indicate lowered resistance to disease/physical weakness/Raynaud’s Disease
* Clubbed ends of fingers/nails - lung disease/emphysema, bronchiectasis, etc.
* Peeling top layers of nail indicate liver weakness
* Very thick nails – can indicate weakening vascular system/ or candida
* Cracked nails – may be deficient in silicon
* Brittle nails - possible iron, zinc, biotin or calcium deficiency/thyroid problems/ kidney or circulation problems/or low in essential fatty acids. Can also be caused by contraceptive pill.
* Flaking nails – low in essential fatty acids
* Splitting nails – can be early sign of psoriasis or thyroid problems
* Thinning nails – may involve skin disease (itching)
* Red skin at the base of the nail – possible connective tissue disorder.
* Nails curving downward – possible heart/liver/respiratory disease/vitamin B12 deficiency (low B12 can be associated with curving up or down)
* Nails curving upward (spoon shaped) – vitamin B 12, iron or chromium deficiency/anaemia/scurvy
* Depression in nails usually marks period of ill health or crash diet. Can take months to grow out.
* Raggedy cuticles – lack of calcium
* Nails separating from nail bed – can be reaction to nail polishes/drug reactions/thyroid/or fungal disease
* Nails can be a window to out health status. They can warn us early of impending problems. If nails are healthy, smooth and pink with a slightly curved surface, you are probably pretty healthy too, but nails that are unhealthy, brittle, discoloured, misshapen, may mean you have a nutritional deficiency or some other health problem.

[Hanna]

and healthy nails are?? or did I miss that?

I find that info very interesting, who would of thought it...I have thinning nails

I just wish they weren't covered in varnish right now

[Fred]

and healthy nails are?? or did I miss that?

None of the above

[jagendog]

Another not so pleasant treatment is removal of the the entire nail or half the nail itself. My big toe was in sad shape on one side of the nail, so I opted for half of the big toe nail removal. They said it would not grow back (wrong) one year later it is fully grown back to it's former condition ....fully deep ingrown again. This was not a pleasant procedure and with the result not as stated I would only use in a desperate condition. Procedure is almost torture of the Inquisition times.

[KatT]

Ouch    

Never had that done and hopefully will never need to.  That being said, is it possible that they did not remove the root of the nail ?

[Kat]

I had nail removal on one of my big toes and they used some medicine or some such so that it wouldn't grow back, and it didn't.

Not something I recommend unless it's absolutely necessary.

[jagendog]

This nail specialist sent me there by my dermatologist, so Iam confident they did what was needed to do, Perhaps I should have had the entire nail removed, Recovery was long and tedious, soaking 3  times a day with beta carotine. a strong antiseptic 3 times a day for 2 weeks, Thank You Folks for Your Help

[Kat]

This nail specialist sent me there by my dermatologist, so Iam confident they did what was needed to do, Perhaps I should have had the entire nail removed, Recovery was long and tedious, soaking 3  times a day with beta carotine. a strong antiseptic 3 times a day for 2 weeks, Thank You Folks for Your Help

Yes, sometimes it's necessary, I just meant it's not a fun experience. Sorry to hear that yours grew back the same way.