Psoriatic nail disease

Overview

Psoriatic nail disease is a condition where psoriasis affects the fingernails or toenails. Psoriasis is a long-term skin condition that causes red, scaly patches. When it affects the nails, it can cause changes like pitting (small dents), thickening, or discoloration.

It is fairly common among people who have psoriasis. About half of people with psoriasis have nail changes at some point.

It can affect anyone with psoriasis, but it is more common in adults than children. It also tends to be more common in people with psoriatic arthritis.

Symptoms

Common symptoms

• Small dents or pits on the nail surface
• Thickening of the nail
• White, yellow, or brown discoloration
• Nail lifting away from the nail bed (onycholysis)
• Crumbling or breaking of the nail
• Red or brown spots under the nail (splinter hemorrhages)

Symptoms in children

• Similar to adults but may be harder to spot because children's nails grow faster and changes can be subtle
• Pitting and discoloration are the most common signs

Symptoms in older adults

• Thickening and crumbling may be more pronounced
• Often combined with fungal infections, which can make diagnosis trickier

Causes

Main causes

• Psoriatic nail disease is caused by an overactive immune system that mistakenly attacks healthy nail cells, leading to inflammation and abnormal nail growth.
• It is linked to the same genetic factors that cause psoriasis.

Risk factors

• Having psoriasis on the skin or scalp
• Having a family history of psoriasis or psoriatic arthritis
• Having psoriatic arthritis
• Stress, infections (like strep throat), or injury to the nail can trigger flare-ups

When to see a doctor

See a doctor urgently if:

• If you have sudden severe pain, redness, or swelling around a nail, along with fever
• If you cannot move your finger or toe normally due to pain or swelling

Book a routine appointment if:

• If you notice changes in your nails that last more than a few weeks
• If you have psoriasis and develop nail problems
• If you have joint pain or stiffness along with nail changes

Diagnosis

A doctor – usually a dermatologist (skin specialist) – can often diagnose psoriatic nail disease by looking at your nails. They will ask about your medical history and whether you or your family have psoriasis or psoriatic arthritis.

Tests that may be done

• Nail clipping or scraping to check for fungal infection (since fungus can look similar)
• Blood tests if psoriatic arthritis is suspected

What to expect at your appointment

The doctor will examine your nails and may look at your skin and joints. Diagnosis is usually straightforward. If there is doubt, a small sample of nail may be sent to a lab.

Treatment

Treatment aims to improve the appearance of the nails, reduce discomfort, and prevent them from getting worse. It depends on how severe the changes are and whether you have psoriasis elsewhere or joint pain.

Self-care at home

• Keep your nails short and clean to avoid catching them
• Moisturise your cuticles and nails with emollients (moisturising creams)
• Avoid picking or trimming cuticles too aggressively, as this can worsen changes
• Wear gloves when doing wet work or gardening to protect nails

Medical treatments

Your doctor may recommend creams or ointments applied to the nails, such as vitamin D or steroid preparations. For more stubborn cases, treatments may include light therapy (phototherapy) or medications that affect the immune system. These are taken by mouth or injection. Your doctor will discuss the best option for you. Never use over-the-counter treatments for fungus unless confirmed by a doctor.

When is surgery considered?

Surgery is very rarely needed for psoriatic nail disease. In extremely severe cases with infection or pain, a doctor might remove part of the nail, but this is uncommon.

Living with this condition

Psoriatic nail disease can be frustrating, but small changes can help you manage. Keep nails filed smooth to avoid snags. If nails are brittle, use a nail strengthener (not medicated). Emollients can help dryness.

Lifestyle tips

• Avoid trauma to the nails – wear protective gloves for chores
• Keep nails dry and clean to prevent infection
• Manage stress with relaxation techniques, as stress can trigger flare-ups

Diet and exercise

Eating a balanced diet and staying active is good for overall health. Some people find that certain foods like alcohol or processed foods worsen psoriasis, but there is no one-size-fits-all diet. Stay hydrated.

Mental health and emotional wellbeing

Nail changes can be embarrassing and affect self-confidence. It is normal to feel self-conscious. Talk to your doctor if you feel distressed. Remember, you are not alone, and treatments can improve the appearance.

Prevention

There is no sure way to prevent psoriatic nail disease if you have psoriasis. But you can reduce flare-ups by avoiding injury to nails, managing stress, and following your treatment plan.

Complications

If left untreated

• Nails may become thick, painful, or crumble over time
• Increased risk of fungal or bacterial infections
• Difficulty with daily tasks like buttoning clothes or typing
• If related to psoriatic arthritis, joint damage can happen without treatment

Long-term outlook

With proper care and treatment, most people with psoriatic nail disease can see improvement in their nails. Nails grow slowly, so it can take months to see results. Treatment can reduce symptoms and prevent the condition from getting worse. Many people lead normal lives with this condition.

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