Is It Nail Fungus or Nail Psoriasis?

If you have psoriasis on your hands or 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 half of people with psoriasis have nail psoriasis. For those also living with psoriatic arthritis, close to 80 percent experience nail psoriasis.¹

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

What are the similarities?

Both nail psoriasis and fungal infections can occur in the toenails and fingernails. While nail psoriasis is more likely to affect the fingernails, nail fungus is more likely to affect the toenails.^1,2

Other similarities include:^1-4

• Discoloration of the nail – Both psoriasis and fungal infections can cause discoloration of the nails. People with psoriasis often notice that their nails change to a yellowish-brown color, while people with fungal infections see yellow, brown, and green colors.
• Nail lifting or falling off – Both conditions can have a symptom where their nails separate from the nail bed or even fall off. This is known as onycholysis.
• Nail thickening – Both conditions can cause the nails to thicken.

What are the differences?

There are a few key differences between the two conditions. Nail fungus has a few symptoms that generally do not occur with nail psoriasis. These include:^2,4

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

Nail psoriasis also has a few unique symptoms that do not usually occur in fungal infections. These include:^1,3

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

Risk factors

As mentioned above, 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 you have been exposed to more fungi than when you were younger.
• Having other health issues – People 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 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 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 the treatment options?

There are treatments for both nail fungus and nail psoriasis. Nail fungus is usually treated with medicine. You may be given a topical drug to apply directly to the nail. These drugs are available as creams and polishes and may be used along with other treatments.²

People with nail fungus may also be prescribed an oral antifungal medication. These can be used with or without topical treatments.²

Nail psoriasis, on the other hand, can be treated with topical corticosteroids. Some people have more success with corticosteroid injections under the nail since it is difficult for topical medications to get through the nail into the nail bed.^1,3

If necessary, both conditions can be treated by removing the nail. While this may sound awful, it is actually a relatively painless procedure.^2,3

Always talk to your healthcare team

Always consult your doctor about the best treatment for your needs. Since these conditions can happen together, your doctor should help you decide on the best treatment for your situation. They also can help you learn how to prevent future infections or flares.