Is It Nail Fungus or Nail Psoriasis?

If you have psoriasis on your hands or your feet, you may have noticed that the appearance of your fingernails and toenails has changed. Psoriasis can affect your nails as well as your skin, and as many as 50% of patients with psoriasis have some involvement with their nails.¹ For those living with psoriatic arthritis, this number might be closer to 80% of patients who experience nail changes.

Both conditions have similar symptoms but are treated differently

To make this situation more complicated, patients with psoriasis are at a higher risk for nail funguses.² Both nail fungus and nail psoriasis can have similar symptoms but are treated very differently.

This article will discuss some of the similarities, differences, risk factors and treatments of both nail fungus and nail psoriasis.

What are the similarities?

Both can occur in the fingers and toes. Both nail psoriasis and fungal infections can happen in the toenails and fingernails. Nail fungus is more likely to happen in the toenails, while nail psoriasis is more likely to affect the fingernails.^1,2

Other similarities include:

• Discoloration of the nail: Both psoriasis and fungal infections can cause discoloration of the nail. Patients with psoriasis often notice their nails change to a yellowish-brown color, while patients with fungal infections see yellow, brown and green colors.^3,4
• Nail lifting or falling off: Both conditions can have a symptom where their nails separate from the nail bed or even fall off.^3,4 This is known as “Onycholysis.”
• Nail thickening: Both conditions can cause the nails to thicken.^1,2

What are the differences?

There are a few key differences between the two conditions. Nail fungus has a few symptoms that generally don’t occur in nail psoriasis. These include:

• Debris under the nail that can look dark in color^2,4
• Brittle nails that are more likely to split^2,4
• A mild, foul-smelling odor²

Nail psoriasis also has a few unique symptoms, that don’t usually occur in fungal infections. These include:

• Pitting of the nail, (small dot-like dents that give it a thimble-like look)¹
• Deformed nail shape³

Let's take a look at risk factors

As discussed earlier, having psoriasis can put you at risk for nail fungal infections. While the only risk for getting nail psoriasis is having psoriasis on your hands and feet, there are quite a few risk factors for nail fungus.^2,4

• Age: You are more likely to get nail fungus infections as you get older. This can because your nails grow slower, your circulation is not as good, and because you have been exposed to more fungi than when you were younger.
• Having other health issues: Patients with cancer, diabetes, poor circulation, and poor immune systems are more likely to have nail fungal infections.
• Exposure to damp environments: Fungus thrives in damp environments. If you notice that your socks are damp every time you take them off, you have to wear gloves a lot for your job, or you often walk barefoot in places like locker rooms, or pools, you are at higher risk for nail fungal infections.
• Wearing artificial nails: Make sure that your salon uses new or freshly sterilized instruments every time you get your nails done. Additionally, acrylic nails can separate from the natural nail, leaving a place for fungus to grow.

What are treatment options?

There are treatments for both nail fungus and nail psoriasis. Nail fungus is usually treated with medication. Patients may be given topical medication that is applied directly to the nail.²

These are available as creams and polishes and may be used in conjunction with other treatments. Nail fungus patients may also be prescribed an oral antifungal medication.² Oral medications are usually given for 12 weeks to 6 months. They can be used with or without topical treatments.

Nail psoriasis can be treated with topical corticosteroids.¹ Some patients have had success with corticosteroid injections under the nail since it is difficult for topical medications to get through the nail into the nail bed.³

Always talk to your healthcare team

Both conditions can be treated by removing the nail. While this sounds awful, it is actually a relatively painless procedure.^2,3

Always consult your healthcare team about the best treatment for your needs. Since these conditions can happen simultaneously, and your team should help you decide the best way to treat your condition and help you learn how to prevent another outbreak.