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:
Discoloration
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.
Signs, Symptoms and Complications
- Crumbling. The fast growing cells combined with the damage to the nail bed and underlying structures can force the nail to crumble and lift off. Sometimes the skin underneath the nail will thicken, which forces the nail to loosen.
Your nails protect your fingers and toes, so lifting and crumbling nails leave you more vulnerable to infection and injury. In some cases, inflammation around the nail (paronychia) and fungal infections will complicate matters even more, so it’s important to start treatment as soon as possible.
Getting the Right Diagnosis
Nail psoriasis symptoms are pretty apparent, but they can also be easy to mistake for other problems. If you’re one of the 5 percent who develops nail psoriasis without any skin symptoms, it can be particularly challenging for your doctor to land on the right diagnosis.
Luckily, there are some ways to get to the bottom of your nail issue, and onto a good treatment plan. The more information you can provide your doctor, the better your chances of a quick and accurate diagnosis, especially when your symptoms mimic multiple conditions.
Know Your Family History
Up to 40 percent of psoriasis sufferers have a parent or sibling with the disease, too. In some cases, they may have a very mild case that goes unnoticed, so do your homework and ask your family about any suspicious akin or nail symptoms they might have had in the past.
Your risk of developing psoriasis jumps to 75 percent if both your parents have the condition, so it’s important that you relay this information to your doctor — it could be the missing piece of the puzzle that leads to the right diagnosis.
Report Any Nail Trauma or Infection
Nail psoriasis tends to come on suddenly and unexpectedly, like the other forms of psoriasis. However, other common nail problems, like fungal infections or injuries to the nail plate, can be traced back to a specific event or illness.
If you see changes to your nail after a manicure, small injury, using a public pool or workout space, or working in a moist and humid environment for a long stretch of time, let your doctor know. Fungal infections account for about half of all nail abnormalities.
If your doctor is unsure what’s causing your nail problem, they might decide to take a biopsy of the skin underneath the nail. If psoriasis is detected, there are a couple of courses of action: either chemical or surgical removal of the nail, or management of symptoms with medication.
Self-Care for Better Nails
While there is no home remedy for nail psoriasis, your daily nail care can help you keep discomfort and damage to a minimum. If your nails are chipping away or peeling back, carefully clip the loose or crumbly areas back as needed. The less excess hanging off your nailbed, the less likely you are to get it caught on something.
Be sure to clip carefully, and look closely for any new wounds or signs of infection, so you can treat it before it becomes a bigger problem. Since dry nails (like dry skin) can lead to cracks and fissures, try to keep your hands dry and your nails moisturized, and consider wearing soft gloves to protect them from the elements.