Nail Psoriasis

Question:
My psoriasis has always been mild, but now I am starting to have problems with my fingernails. Is there anything I can do to improve this unsightly condition?

Answer:
Psoriasis, an inherited condition mediated by the immune system, is one of the most common skin diseases, affecting more than 4.5 million Americans. Psoriasis occurs when faulty immune system signals accelerate the cycle of skin cell growth, an ongoing process in which cells mature and are shed from the skin. During these psoriasis "flares" extra cells pile up on the skin's surface and form the hallmark lesions of the disease. These red flaky patches, called plaques, are often itchy, uncomfortable, and embarrassing. Psoriasis often appears on joints, limbs, and scalp, but can crop up anywhere on the body including the fingernails and toenails. About half of all people with psoriasis experience nail changes.

Nail psoriasis can appear as:

• Clear yellow-red nail discoloring that looks like a drop of blood or oil under the nail plate, sometimes called an oil drop or a salmon patch.
• Small pits.
• Lines going across the nails (side to side, not bottom to top). Cells respond to psoriasis by becoming inflamed from time to time, which causes these lines in your nails.
• White areas of white on nails.
• Thickening of the skin under nails that can lead to loosening of the nail.
• Loosening of the nail. Your nail may develop a white area where it is separated from the skin underneath your nail. It usually starts at the tip of the nail and extends toward the root. Skin under nail can become infected.
• Crumbling nails, which ooccures because underlying nail structures are not healthy.
• Tiny black lines in your nail from the top towards the root.
• Redness of the pale arched area at the bottom of your nail.
• Arthritis of your fingers with nail changes. Nails are affected in up to 80% of people who have psoriatic arthritis.

Unfortunately, nail psoriasis is hard to treat, as the problem arises deep in the nail bed, and there is no cure for the condition. A doctor may be able to improve the appearance of your nails, however.

If your nails are pitted, discolored, loosening, or seem infected, seek medical care, preferably from a dermatologist. A dermatologist may suggest topical steroids, antifungal medication (sometimes a fungal infection occurs along with nail psoriasis), light therapy, or, if nail psoriasis is severe, potent systemic medications for psoriasis that are given as pills or infusions.

In many cases, self-care can help improve your nails appearance.

• Keep nails as short as possible.
• Trim fingernails back to the point of firm attachment with manicure scissors. For toenails, gently file thickened part of the toenail areas and remove one small piece at a time with strong clippers made for toenails - these are larger and sturdier than fingernail clippers. Cut straight across the toenail to help keep it from becoming ingrown. Wearing roomy shoes leaves room for the toes and helps avoid the friction that can cause toenails to thicken. Be gentle with your nails as you work!
• Protect your hands. Bumping, pulling, and scraping your nails can make psoriasis worse. Be gentle when you clean and trim your nails and consider wearing gloves when you are doing vigorous work with your hands.
• Try soaking your nails in three capfuls of tar bath oil and warm water. Soak your fingers for 20 minutes and then rub moisturizer into each nail. Most drug stores sell a variety of tar bath oils. Soaking also can help toenails.
• If your nails are mostly intact, nail hardener or nail polish can improve their appearance.

UAB dermatologists advise people who have nail psoriasis and get manicures to make sure the technician is gentle with their nails. Cuticles should not be trimmed. Nails can be filed, but this needs to be done with care. Experts also note that light therapy can help your nails just as it improves the skin of some people with psoriasis. If you get manicures at your local salon, get clear polish or go in when your nails are free of polish and put your hands under the light lamps for 10 minutes. For more information on nail psoriasis visit the National Psoriasis Foundation.