The guide of nail psoriasis: symptoms, causes & treatment options

Your Ultimate Guide to Nail Psoriasis, and Psoriasis of the Nail Symptoms, causes & treatment options

The guide of nail psoriasis: symptoms, causes & treatment options

Dealing with nail psoriasis may be tough – those pesky nail changes and issues are unsightly and can be painful too. But don't worry, you're not alone! This comprehensive guide will help you better understand this condition and provide tips on managing it effectively. Buckle up, because we're diving deep into the world of nail abnormalities!

Here is a quick summary of what this guide covers:

Nail psoriasis is a common skin condition that often accompanies psoriasis, causing changes in the appearance and structure of your nails. This blog will explore the symptoms, causes, treatment options, and vital tips to help you keep your nails healthy and happy. Whether you're a long-time sufferer or just starting to notice changes, this guide has got you covered!

1. Which body areas does research indicate are the most prone locations that psoriasis can affect?

Psoriasis is a skin disease that can rear its ugly head on various body parts. While it's most commonly associated with red, scaly patches on the elbows, knees, and scalp, research shows that it also has a particular fondness for the nails. Up to 50% of patients with psoriasis may eventually form nail changeovers. So, if you're dealing with psoriasis, keeping an eye on those digits is crucial!

2. What are the most common symptoms of nail psoriasis?

Nail psoriasis may manifest in various ways, but some of the most common symptoms include:

  • Pitting: These are tiny dents or holes in the nail plate that resemble the craters on the moon.
  • Discoloration: Your nails may turn yellow, brown, or even reddish.
  • Ridging: Horizontal or vertical ridges can appear on the surface of the nail.
  • Onycholysis: This fancy term refers to the separation of the nail plate from the nail mattress.
  • Subungual hyperkeratosis: It's a mouthful, but it simply means a buildup of chalky material under the nail.

3. How does nail psoriasis present and what causes nail changes and issues?

Nail psoriasis is caused by the same underlying immune system issues that trigger psoriasis elsewhere in the body. When your immune system goes into overdrive, it produces an excessive amount of skin cells, leading to the characteristic plaques and scales associated with psoriasis.

In the case of nail psoriasis, this rapid cell turnover affects the nail matrix – the area where your nails grow. As a result, the nail cells don't mature properly, causing those telltale pits, ridges, and discoloration we discussed earlier. It's like your nails are having a constant identity crisis!

4. What percentage may develop nail psoriasis and what does the epidemiological research say about chances?

According to epidemiological studies, the chances of forming nail anomalies are pretty high if you have plaque psoriasis (the most common type). Research suggests that anywhere from 10% to 78% of patients with psoriasis may experience nail involvement, with an average of around 50%.

Now, those are some pretty broad percentages, but it just goes to show how variable this condition can be. The severity of your nail anomalies is often related to the severity of your overall psoriasis, so if you have moderate-to-severe cutaneous psoriasis, you're more likely to have moderate-to-severe nail issues as well.

5. Being psoriasis is a common condition that regularly impacts nails?

You betcha! Nail involvement is incredibly common in individuals with psoriasis. Some studies estimate that up to 90% of patients with psoriasis and psoriatic arthritis will experience nail changeovers at some point during their lifetime.

Nails are often one of the first areas to be affected by psoriasis, sometimes even before the classic skin lesions appear. So, if you notice any funky business with your nails, it could be an early sign that something more is going on.

6. What typical nail changes occur and how can they appear in nail beds and areas where nails grow?

When it comes to nail psoriasis, there's a whole host of changes that can occur. Let's take a closer look at some of the most common ones:

  • Pitting: As we mentioned earlier, these tiny dents or holes in the nail plate are a classic sign of nail psoriasis. They occur when the nail cells don't mature properly, leaving little craters behind.
  • Onycholysis: This is where the nail starts to separate from the nail bed, often starting at the tip and working its way back. It can be painful and even lead to fungal infections if left untreated.
  • Subungual hyperkeratosis: This fancy term refers to a buildup of chalky material under the nail, which can cause it to thicken and yellow.
  • Splinter hemorrhages: These are thin, brown-black lines that look like splinters under the nail. They're caused by tiny areas of bleeding beneath the nail plate.
  • Nail bed changes: The nail mattress itself can become red, swollen, and even cracked or blistered in severe cases.

And if that's not enough, nail anomalies can also affect the nail root – the area where your nails grow. Changes here can lead to ridging, pitting, and even complete nail shedding if left unchecked.

7. What treatment recommendations does the National Psoriasis Foundation provide for nail management?

The National Psoriasis Foundation (NPF) is a leading authority on all things psoriasis-related, including nail management. Here are some of their top recommendations for keeping your nails in tip-top shape:

  • Topical treatments: These include steroid creams, vitamin D analogs, and even injectable medications that can be applied directly to the affected nails.
  • Oral medications: For more severe cases, systemic treatments like methotrexate or biologic drugs may be prescribed to address the underlying inflammation.
  • Intralesional injections: Injecting steroids directly into the nail bed or matrix can help reduce inflammation and improve nail growth.
  • Phototherapy: Exposing your nails to specialized UV light can slow down the rapid cell turnover that causes nail changeovers.

The NPF also emphasizes the importance of regular nail care, such as keeping nails trimmed and moisturized, and avoiding anything that could further traumatize the nails.

8. What issues are often associated with nail psoriasis and what areas around nails are impacted?

Nail psoriasis is more than just a cosmetic issue – it can also lead to some pretty unpleasant side effects. Here are a few common problems that often accompany those pesky nail changeovers:

  • Pain and discomfort: As the nail separates from the bed or thickens, it can become incredibly painful, making simple tasks like typing or buttoning a shirt a real ordeal.
  • Increased risk of infection: Those cracks and separations in the nail provide the perfect breeding ground for fungi and bacteria to take up residence.
  • Emotional distress: Let's face it, having visibly damaged nails can take a toll on your self-confidence, especially in our appearance-conscious society.

And it's not just the nails themselves that are affected – nail anomalies can also impact the surrounding areas. The nail folds (the skin around the nails) can become red, swollen, and cracked, while the cuticles may overgrow or become painfully inflamed.

9. What nail matrix and bed signs develop and what pitting and ridging often signal?

The nail matrix is the area where your nails grow, and it's often ground zero for many of the changes seen in nail psoriasis. Here are some of the telltale signs that can develop in this crucial region:

  • Pitting: Those tiny dents or holes in the nail plate are a classic sign that something's amiss in the nail root. They occur when the nail cells don't mature properly, leaving little craters behind.
  • Ridging: Both horizontal and vertical ridges can form on the nail plate, signaling that the matrix is not functioning as it should.
  • Nail shedding: In severe cases, the entire nail can detach from the matrix, a condition known as onychomadesis. It's like your nail is staging a full-on revolt!

But it's not just the matrix that can be affected – the nail mattress (the area between the matrix and the fingertip) can also show signs of trouble. Some common issues include:

  • Subungual hyperkeratosis: That chalky buildup under the nail? That's subungual hyperkeratosis, and it's a surefire sign that the nail mattress is inflamed.
  • Onycholysis: When the nail starts to separate from the bed, it's known as onycholysis. This painful condition leaves space for fungi and bacteria to sneak in, so it's one to watch out for.

10. What topical and oral treatment options exist to treat nail psoriasis and how can I care for affected areas?

When it comes to managing nail psoriasis, there are a variety of topical and oral treatment options available. Let's dive into some of the most commonly used ones:

Topical Treatments:

  • Corticosteroid creams or solutions: These can help reduce inflammation and slow down the rapid growth of skin cells. They're often used for mild to moderate nail anomalies.
  • Calcipotriene: This vitamin D analog can be applied directly to the nails to help slow down skin cell growth and improve nail appearance.
  • Tazarotene: A vitamin A derivative that can help normalize skin cell development and improve nail quality.

Oral Medications:

  • Methotrexate: This immunosuppressant medication can help control the overactive immune response that causes psoriasis and nail changeovers.
  • Acitretin: A synthetic form of vitamin A that can help regulate skin cell growth and improve nail thickness and appearance.
  • Biologics: These targeted medications, like adalimumab and etanercept, work by blocking specific proteins involved in the inflammatory process.

In addition to medical treatments, some nail care techniques can help manage nail anomalies:

  • Keep nails trimmed short to prevent snagging and further damage.
  • Moisturize regularly with thick, creamy products to keep nails and surrounding skin hydrated.
  • Protect nails from trauma by wearing gloves for tasks like gardening or cleaning.
  • Gently file down thick, crumbly nails to improve appearance and prevent snagging.
  • Consider wearing artificial nails or wraps to camouflage severe nail changeovers.

11. What are the most effective treatments for nail psoriasis according to research?

While there's no one-size-fits-all solution for nail psoriasis, research has shed light on some of the most effective treatment methodologies. Here's what the experts say:

Topical Treatments:

  • High-potency corticosteroids: Studies have shown that topical steroids like clobetasol can significantly improve nail psoriasis when applied directly to the affected nails.
  • Calcipotriene: This vitamin D analog is particularly effective in treating nail mattress involvement and improving nail appearance.

Oral Medications:

  • Methotrexate: This tried-and-true immunosuppressant has been shown to improve nail psoriasis in up to 35% of patients.
  • Acitretin: This vitamin A derivative is especially useful in treating nail root involvement and preventing new nail lesions from forming.


  • Adalimumab (Humira) and Etanercept (Enbrel): These biologic medications, which target specific inflammatory proteins, have been shown to significantly improve both skin and nail lesions in patients with psoriasis.

Combination Therapy:

  • Research suggests that combining different treatment modalities, such as topical and systemic therapies, can be more effective than using just one approach alone.

It's important to note that everyone's response to treatment can vary, and what works for one person may not work as well for another. Working closely with a dermatologist to find the right combination of therapies is key to managing nail anomalies effectively.

12. What factors are thought to play a role in the etiology of nail psoriasis?

While the exact causes of nail psoriasis are not fully understood, researchers believe that a combination of genetic and environmental factors plays a role in its development. Let's take a closer look at some of the key factors involved:


  • Nail psoriasis tends to run in families, suggesting that certain genetic variations may predispose some individuals to developing the condition.
  • Specific genes, such as those involved in immune system regulation and skin cell development, have been linked to an increased risk of nail anomalies.

Immune System Dysregulation:

  • Like other forms of psoriasis, nail psoriasis is thought to be an autoimmune disorder, where the body's immune system mistakenly attacks healthy skin cells.
  • Triggers such as stress, infections, or certain medications can potentially set off this immune response, leading to the characteristic nail changeovers.


  • Nail trauma, whether from physical injury or repetitive stress, can sometimes trigger or exacerbate nail anomalies in susceptible individuals.
  • This is known as the Koebner phenomenon, where psoriatic lesions develop in areas of skin injury.

Other Medical Conditions:

  • Individuals with certain chronic diseases, such as psoriatic arthritis, metabolic syndrome, or inflammatory bowel disease, are at an increased risk of forming nail abnormalities.
  • The underlying inflammation associated with these conditions is thought to contribute to the development of nail changeovers.

While these factors certainly play a role, it's important to note that the exact etiology of nail psoriasis is still not fully understood, and ongoing research is needed to unravel the complex interplay between genetics, immunology, and environmental influences.

13. What have investigations into the epidemiology of nail psoriasis found on clinical features of nail psoriasis?

Epidemiological studies have provided valuable insights into the clinical features and prevalence of nail psoriasis. Here are some key findings:


  • Nail involvement is extremely common in individuals with psoriasis, with estimates ranging from 10% to 78% of patients affected.
  • The prevalence of nail psoriasis tends to increase with age and disease duration, suggesting that nail changeovers may become more frequent as the condition progresses.

Clinical Features:

  • Pitting is one of the most commonly reported nail changeovers, occurring in up to 70% of patients with nail psoriasis.
  • Other common features include onycholysis (separation of the nail plate), subungual hyperkeratosis (chalky buildup under the nail), and nail discoloration.
  • The pattern and severity of nail changeovers can vary significantly between individuals, with some experiencing only mild pitting and others developing severe nail dystrophy or complete nail shedding.


  • Nail psoriasis is more common in patients with plaque psoriasis (the most prevalent form) compared to other types, such as guttate or erythrodermic psoriasis.
  • The presence and severity of nail changeovers often correlate with the extent and duration of skin psoriasis, suggesting a link between the two manifestations.
  • Patients with psoriatic arthritis are more likely to experience severe nail involvement compared to those with cutaneous psoriasis alone.

These epidemiological findings have not only shed light on the clinical characteristics of nail anomalies but have also highlighted the need for early recognition and management of this debilitating condition.

14. How does the presentation of nail psoriasis typically manifest based on studies?

According to numerous studies, the presentation of nail psoriasis can vary widely, but certain patterns and characteristics tend to emerge. Here's what the research has found:

Nail Matrix Involvement:

  • Changes in the nail root, the area where the nail grows from, are common in nail psoriasis.
  • These can manifest as pitting (small depressions in the nail plate), ridging (horizontal or vertical lines on the nail), and nail plate crumbling or shedding.
  • Matrix involvement is often seen in the fingernails but can also affect toenails.

Nail Bed Involvement:

  • The nail bed, the area between the nail root and the fingertip, is another frequent site of involvement.
  • Nail bed changes can include onycholysis (separation of the nail covering from the bed), subungual hyperkeratosis (chalky buildup under the nail), and splinter hemorrhages (thin, brown-black lines under the nail).
  • These changes are more common in toenails than fingernails.

Severity and Distribution:

  • The severity of nail psoriasis can range from mild (a few pits or ridges) to severe (complete nail dystrophy or shedding).
  • Involvement is often asymmetric, with some nails being affected more than others.
  • In some cases, all nails (both fingers and toes) may be impacted, a condition known as "20-nail dystrophy."

Associated Findings:

  • Nail psoriasis is frequently accompanied by changes in the surrounding skin, such as paronychia (inflammation of the nail folds) and periungual erythema (redness around the nails).
  • Patients with nail psoriasis may also experience pain, discomfort, and an increased risk of secondary infections due to compromised nail integrity.

While these are some of the most common presentations, it's important to note that nail psoriasis can manifest in various ways, and a thorough examination by a dermatologist is necessary for an accurate diagnosis and appropriate treatment plan.

15. how can progression be contained through plans targeting regions to prevent nail psoriasis in areas it typically impacts?

Nail psoriasis can be a stubborn and persistent condition, but some strategies can help contain its progression and prevent it from spreading to unaffected nails. Here are some tips:

Target the Nail Matrix:

  • Since the nail matrix is the root of the problem (literally!), addressing issues in this area is crucial.
  • Topical treatments like high-potency corticosteroids or calcipotriene can be applied directly to the nail root to slow down the rapid cell turnover that causes pitting, ridging, and other changes.
  • Intralesional injections of corticosteroids into the nail root can also be an effective way to deliver targeted treatment.

Protect Uninvolved Nails:

  • If you have some nails that are still unaffected, take steps to keep them that way!
  • Wear gloves when doing activities that could potentially traumatize the nails, as nail injury can trigger the Koebner phenomenon and lead to new psoriatic lesions.
  • Keep nails trimmed and filed smooth to prevent snagging and further damage.

Address Surrounding Inflammation:

  • Nail psoriasis often goes hand-in-hand with inflammation in the surrounding skin, such as paronychia (nail fold inflammation) or periungual erythema (redness around the nails).
  • Treating this inflammation with topical corticosteroids or calcineurin inhibitors can help prevent it from spreading to the nails themselves.

Consider Systemic Therapy:

  • For severe or widespread nail involvement, systemic medications like methotrexate, acitretin, or biologics may be necessary to get the underlying inflammation under control.
  • These systemic therapies can help prevent the formation of new nail lesions and improve existing ones.

Manage Triggers:

  • Certain factors like stress, infections, or medications can potentially trigger or worsen nail psoriasis flare-ups.
  • Identifying and managing your triggers can help prevent these flare-ups and halt the progression of nail changeovers.

Be Consistent:

  • Sticking to a consistent treatment plan and following your dermatologist's recommendations is key to containing nail psoriasis.
  • Don't get discouraged if you don't see results right away – it can take several months for new, healthy nails to grow out.

By being proactive and targeting the areas where nail psoriasis typically strikes, you can help prevent it from spreading and potentially spare your other nails from getting caught in the crossfire.

16. What treatments of nail psoriasis have been shown to best address symptoms seen in areas it frequently impacts?

When it comes to tackling the symptoms of nail psoriasis in the areas it commonly affects, certain treatments have proven to be particularly effective. Let's take a look:

Nail Matrix Involvement:

  • Intralesional corticosteroid injections into the nail root are highly effective in treating pitting, ridging, and other matrix-related changes.
  • Topical calcipotriene or high-potency corticosteroids applied directly to the matrix can also help improve these symptoms.
  • For severe cases, systemic therapies like methotrexate or biologic drugs may be necessary to address the underlying inflammation and prevent further matrix damage.

Nail Bed Involvement:

  • Topical treatments like corticosteroids or calcipotriene can help treat nail mattress symptoms like onycholysis (separation of the nail covering) and subungual hyperkeratosis (chalky buildup).
  • However, for more significant nail mattress involvement, systemic treatments like acitretin (a vitamin A derivative) or biologic therapies may be required to effectively address the issue.

Surrounding Skin Inflammation:

  • Topical corticosteroids or calcineurin inhibitors (like tacrolimus or pimecrolimus) can be highly effective in reducing inflammation in the nail folds and surrounding skin.
  • Managing this inflammation is crucial, as it can contribute to further nail damage and potentially trigger the development of new lesions.

Combination Therapy:

  • In many cases, a combination of topical and systemic treatments may be necessary to adequately address the various symptoms and areas affected by nail psoriasis.
  • For example, a patient might use topical treatments for the nail root while taking oral or biologic medication to target overall inflammation and nail mattress changes.

It's important to note that the specific treatment approach will depend on the individual patient's symptoms, severity, and overall health status. Working closely with a dermatologist to develop a personalized treatment plan is essential for achieving optimal results.

17. What do epidemiological studies show about how often people with psoriasis develop nail psoriasis?

Epidemiological studies have provided valuable insights into the prevalence of nail psoriasis among individuals with psoriasis. Here's what the research has revealed:

High Prevalence:

  • Nail involvement is incredibly common in individuals with psoriasis, with estimates ranging from 10% to 80% of patients affected.
  • On average, around 50% of individuals with psoriasis are reported to form nail changeovers at some point during their disease.

Increasing Risk with Age:

  • The prevalence of nail psoriasis tends to increase with age, suggesting that the risk of forming nail involvement may rise as individuals grow older and have had psoriasis for longer.
  • Some studies have found that up to 70% of patients over 60 with psoriasis experience nail changeovers.

Association with Disease Severity:

  • Nail psoriasis is more prevalent and tends to be more severe in individuals with moderate-to-severe plaque psoriasis, compared to those with milder forms of the disease.
  • Patients with psoriatic arthritis also have a higher likelihood of developing nail involvement, often with more substantial nail changeovers.

Variations by Population:

  • The prevalence of nail psoriasis can vary across different populations and geographic regions, likely due to a combination of genetic, environmental, and cultural factors.
  • For example, some studies have reported higher rates of nail involvement among certain ethnic groups or in specific geographic areas.

While the exact prevalence rates can differ across studies, the overwhelming evidence suggests that nail psoriasis is an extremely common manifestation of psoriasis, affecting a significant proportion of patients. These epidemiological findings underscore the importance of routine nail examinations and prompt management of nail changeovers in individuals with psoriasis.

18. What nail care techniques can help people with psoriasis affecting their nails?

While medical treatments are often necessary to manage nail psoriasis, several nail care techniques can help minimize discomfort and prevent further damage. Here are some tips:

Gentle Nail Trimming and Filing:

  • Keep nails trimmed short and file them regularly to prevent snagging and tearing.
  • Use a fine-grit nail file and file in one direction to avoid further trauma to the nails.
  • Be extra gentle when filing thickened or crumbly nails, as they are more prone to splitting and peeling.


  • Apply thick, creamy moisturizers to the nails and surrounding skin to help prevent dryness and cracking.
  • Look for products containing ingredients like urea, lactic acid, or alpha-hydroxy acids, which can help soften thickened nails.

Protective Measures:

  • Wear gloves when doing activities that could potentially traumatize the nails, such as gardening, cleaning, or working with chemicals.
  • Consider wearing cotton gloves at night to prevent scratching or picking at affected nails while sleeping.

Nail Wraps or Artificial Nails:

  • For severely damaged or disfigured nails, nail wraps or artificial nails can provide a cosmetic solution while also protecting the underlying nail.
  • These should be applied and removed by a professional to avoid further damage.

Gentle Nail Cleaning:

  • Use a soft-bristled nail brush and mild soap to gently clean under and around the nails, removing debris that could lead to infection.
  • Avoid harsh scrubbing or picking at the nails, as this can worsen the condition.

Proper Footwear:

  • For those with toenail involvement, wear well-fitting shoes with adequate toe room to minimize trauma and pressure on the nails.
  • Consider wearing open-toed shoes or sandals when possible to allow for airflow and prevent moisture buildup.

While these nail care techniques can be helpful, it's important to remember that they should be used in conjunction with appropriate medical treatment prescribed by a dermatologist. By combining proper nail care with effective therapies, individuals with nail psoriasis can manage their symptoms and improve their overall nail health and appearance.

In summary:

Here are the key points to remember about nail psoriasis:

  • Nail psoriasis is a common condition affecting up to 50% of individuals with psoriasis.
  • Symptoms can include pitting, ridging, discoloration, and separation of the nail from the nail mattress.
  • It is caused by the same underlying immune system issues that trigger psoriasis elsewhere in the body.
  • Factors like genetics, trauma, and other medical conditions may play a role in its development.
  • Treatments include topical medications, oral systemic therapies, phototherapy, and proper nail care techniques.
  • Early diagnosis and management are important to prevent further nail damage and potential complications.
  • A combination of medical treatments and consistent nail care is often necessary to effectively manage nail psoriasis.
  • Working closely with a dermatologist is crucial for finding the right treatment approach for your case.

By understanding the causes, symptoms, and available treatment methodologies, you can take an active role in managing your nail psoriasis and minimizing its impact on your daily life and overall well-being.


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