Affecting approximately one half of people with active psoriasis, nail psoriasis refers to the changes in finger and/or toenails caused by the disease. About one half of nail psoriasis patients have to stop their normal daily activities because of pain. Nail changes can occur in one or more nails and vary in severity; most likely the severity will mirror the amount of psoriasis in the nail bed, nail plate, nail matrix, and the skin at the base of the nail. In severe cases, where pustular psoriasis may damage the nail bed, the nail may be permanently lost.
Causes of Nail Psoriasis
Usually, nail psoriasis occurs in patients with psoriasis. It is associated with Psoriatic arthritis (arthritis in fingers and toes), occurring in about 50-85% of these patients.
Signs and Symptoms of Nail Psoriasis
Nail psoriasis may affect the nail plate, nail bed (the tissue under the nail), nail matrix (the tissue from which the nail grows), nail folds, cuticle, and the bones at the end of the fingers. Signs of nail psoriasis vary according to the part of the nail affected and the nature of the deformity.
It is rare that a person develops psoriasis only on the nails and nowhere else on the body. There are five general types of Nail psoriasis; these changes may occur alone or simultaneously. They include:
- Pitting: A deeply pitted nail caused by the deficiencies in nail growth due to psoriasis in the nail matrix, characterized by loss of parakeratotic cells from surface of nail plate.
- Discoloration of the nail bed (yellow or yellowish pink) resembling drops of oil under the nail plate, referred to as an “oil drop” or “salmon patch” caused by psoriasis in the nail bed.
- The appearance of a white area separating and lifting from the nail plate, caused by pockets of air where the nail bed is lifting from the nail bed. This is referred onycholysis, and may be accompanied by inflamed skin around the nail.
- Crumbling and total loss of the nail due to psoriasis causing weakening of the nail matrix.
Psoriasis of the finger and toenails can resemble other conditions such as chronic fungal infection or inflammation of the nail bed.
Treatments and Preventative measures for Nail Psoriasis
The treatment of Nail psoriasis is part of treatment of psoriasis. Approximately one third of patients may have a treatable fungal infection which could help their nails to improve. As a Koebner phenomenon may occur with this type of psoriasis, preventing prevent further damage to the nails is important. Some things to keep in mind include keeping the nails trimmed as a means to prevent rubbing and more irritation; soaking and carefully filing down and moisturizing thickened toenails, and wearing shoes that are comfortable and fit well with enough room to eliminate pressure and friction on the toenails. A variety of treatments used for skin psoriasis treatments are also used to improve Nail psoriasis. Discussing these treatments and the many more options with your physician will help you find the best treatment.
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