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Toenail Psoriasis

Toenail psoriasis causes changes in the appearance of toenails that are very similar to fungal nail infections. Changes caused by psoriasis of the nails (also called psoriatic nail disease) may include discoloring under the nail plate, deformation is the shape or slope pitting of the nails, lines across the nails, thickening of the skin under the nail, and the loosening (onycholysis) or crumbling of the nail.

What is Psoriasis?

Psoriasis is a chronic skin disease. It typically appears as patches of raised, scaly red skin. The skin may look shiny and red or even have pustules, depending on the type of psoriasis. The skin affliction is generally found on the elbows, knees, scalp, and trunk.

Most people who have nail psoriasis also have skin psoriasis. Only 5% of people suffering from nail psoriasis have no other signs of psoriasis. Conversely, people with skin psoriasis have a very strong chance of having the condition appear in their nails. Up to 50% of people with skin psoriasis have nail psoriasis. Of people with psoriatic arthritis, up to 80% have affected nails.

Psoriasis is not contagious. It is not clear how nail psoriasis develops. It appears to result from a combination of genetic (inherited), immunologic, and environmental factors. It tends to run in families. It affects men and women equally and can occur in people of all races.

Nail Psoriasis Symptoms

Nail psoriasis is identified by a number of different changes in the appearance of the toenail or fingernail. Most frequent changes in psoriatic nails include:

  • small holes or pits in the nail plate
  • changes in the normal shape of the nail
  • thickening of the nail or the skin under the nail
  • separation of the nail from the nail bed
  • unusual nail coloration, such as yellow-brown or yellow-red
  • crumbling nails

Toenail Psoriasis Treatment

Currently, there is no cure for nail psoriasis. The objective of treating nail psoriasis is to improve the function and appearance of your toenails and fingernails.

Recommended treatments for toenail psoriasis may include creams or ointments to rub on and around the nail, but the barrier created by the nail plate, often renders topical treatments ineffective. Other treatments for nail psoriasis may include steroids injected under the nail, PUVA (a combination of the prescription medicine psoralen and exposure to ultraviolet light), and systemic (oral or injected) medication.

If your toenails also have a fungal infection, your doctor will likely prescribe an antifungal medication.

If other treatments don't work, your doctor may recommend that your psoriatic toenail be removed, either chemically or surgically. Chemical removal of your toenail involves applying an ointment to your nail for seven days. The nail falls off with no bleeding. With surgical removal of your toenail, the area is numbed with a local anesthetic before the nail is removed.

Toenail Care at Home

Keep psoriatic nails as short as possible. In areas where your nail has loosened, keep the nail trimmed back with manicure scissors to the point where it is firmly attached.

Keeping your psoriatic nails trimmed back serves two purposes. First, it allows your topical medications to reach closer to the source of the problem. Second, it protects your nails from further damage, since loose nails are more likely to encounter injury.

All nail care must be very gentle. The stress of overly vigorous nail care can cause your psoriasis to worsen.

Protect your nails from any type of trauma, which can worsen the psoriasis. If you have toenail psoriasis, wear shoes or other protective footwear to avoid injury to the toenails. If you have psoriasis of the fingernails, wear gloves while working with your hands to prevent damage to the nails.