Telltale Signs of Nail Psoriasis and When to Seek Treatment
Thousands of people live with the itchy, scaly, flaky skin condition known as psoriasis, but some will see symptoms pop up in unexpected places. When psoriasis moves to the nails, it can be much more difficult to handle, especially when it interferes with simple functions most people take for granted.
Like other forms of psoriasis, nail psoriasis can vary widely in severity and symptoms. Some people are annoyed by pits and chips, while others may lose their nails entirely. Although there’s little you can do to prevent the condition from taking hold of your fingers and toes, you can bring it under control — and rule out other complications — with careful monitoring and early detection.
How Common Is Nail Psoriasis?
The different types of psoriasis often come together, but you won’t necessarily develop all of them. In many cases, psoriasis symptoms stay on the skin, where they can be controlled with topical treatments. For the unfortunate few who find their symptoms creeping into their nails, treatment can be more complicated.
Nail psoriasis typically proceeds skin psoriasis: 95 percent have skin psoriasis before they see signs of the disease in their nails, while 5 percent will suffer from nail psoriasis without any symptoms on their skin.
And for those with psoriatic arthritis (when the autoimmune condition causes inflammation in the small joints), nail psoriasis is very likely to develop — up to 86 percent of sufferers will also see the pitting, thickening and flaking that points to nail psoriasis.
Signs, Symptoms and Complications
Psoriasis is generally a very visible disease. When it occurs on the skin, scaly red patches are difficult to ignore; when it occurs on the nails, the damage can be both uncomfortable and unsightly.
Changes can start small — perhaps on only one finger nail — but can spread across the other nails fairly quickly when the disease is in flare. Some of the most common symptoms include:
An injury to your nail can cause bruising or scuff marks, which are typically mild and temporary. In contrast, nail psoriasis brings more pronounced changes to the natural colors of your nails and nail bed.
Look out for these common signs of psoriasis trouble:
- Drops of red or yellow under the nail (known as “oil drops” or “salmon patches”)
- Patches of white (known as midmatrix disease)
- Tiny black vertical lines (points to bleeding capillaries in the tips of the fingers)
- Redness at the base of the nail (known as spotted lunula, this is a sign of congested capillaries)
Sometimes psoriasis will cause the whole nail to yellow as it thickens and chips away. Darker colors often mean blood is trapped under the nails, which could cause pressure to build up.
Changes in Texture
Along with changes in the color of the nail and nail bed, psoriasis can cause your nails to grow differently. Psoriasis symptoms can be blamed on the proliferation of cells: when cells multiply quickly, layers will build up on top of each other.
In the case of nail psoriasis, this leads to thick and uneven nails, with some hallmark texture changes, like:
- Pits. Many people notice small pits in the surface of the nails before any other symptoms show up. These small pits appear when cells are lost from the nail surface.
- Horizontal lines. These indented or ridged lines, known as Beau’s lines, reach from one side to the other side of the nail. They can point to a number of nail problems, including psoriasis.
Next page: how to get the right diagnosis for nail psoriasis.