A collage or pattern of hands and feet.

My Battle With Nail Psoriasis

There are lots of places on the body where psoriasis can occur. Arms, legs, stomach to the face, armpits, and genitals. One part of the body which is particularly difficult is the nails.

What are the symptoms of nail and toenail psoriasis?

I had nail psoriasis in conjunction with psoriasis elsewhere on my body for more than 10 years. At first, I noticed the symptoms – discoloration, thickening, and pitting of the nails – on just one of the nails on my hand. Then it spread to all the nails on the hand. After that, I could see the scales building underneath my fingernails.

But it’s not just on the fingers where nail psoriasis can occur. The toes can also be affected. The symptoms are much the same as the fingernails – discoloration, thickening, and pitting of the nails – with scales building underneath the toenails.

Is nail psoriasis painful?

In some cases where psoriasis affects the nails both on the fingers and toes, you can get ridging or grooves in your nails, and sometimes the nail can actually separate from the nailbed.

The pain that can occur following this or the other symptoms can be tough to deal with. I’ve had times where I’ve cut my nails too short because I’ve not seen the nail-line due to the thickness of the psoriasis plaque. Other times you have to be careful including making sure you don’t accidentally bend the nail. If you do, it can be very painful.

The emotional toll and embarrassment of nail psoriasis

And it’s not just physically where this can hurt, as it can affect you psychologically too. For me, I didn’t want to wear flip-flops, sandals or any shoes which may show my toenails. I was wary of my fingers too but practically couldn’t wear gloves all day, so had to accept that some people would notice them and that was OK.

I never really had any nasty comments, but I did get stares whenever I discussed my nail psoriasis and placed emphasis on my fingernails in public. This did get me down some days as I couldn’t do anything about it.

Only once, when handing over money at a shop counter, did somebody query if it was psoriasis. But it was said in an understanding, curious way and I was happy to tell them more about it and what it’s like. The cashier mentioned that one of her family members had it and she wanted to know what treatment regiment I was on so she could tell them. I was only too happy to tell them.

What are the treatment options for nail psoriasis?

So, what treatments can you be on for nail psoriasis? Generally, your doctor will start with topical treatments like corticosteroids. These include creams that you will rub into the nail where the plaques are.

If that doesn’t work, you may be prescribed cyclosporine or methotrexate. I was on cyclosporine for about 6 weeks and unfortunately, it never did much to clear my nail psoriasis. I have also tried methotrexate with much better outcomes. That did help with the nail psoriasis, but I was taken off it for other reasons shortly after starting, so I didn’t understand the full effect.

My success with UVB therapy for nail psoriasis

If those don’t help, UVB therapy can be effective. For me, outside of biologic treatments which I will mention next, UVB was the best at clearing my nail psoriasis.

But you have to make sure the UVB rays are hitting the plaques under the nail-bed, so you have to think of a way of standing in the UVB booth so that it gets them. For some people, UVB therapy doesn’t work because the rays don’t hit the plaques.

Your next option if UVB fails is to get biologic therapies. As I’ve mentioned in previous pieces, for me, this has been the best option. The biologic targets the overactive immune cells directly by suppressing them, so they are much more successful at treating the condition than other forms of medication.

I have been on Stelara and Cosentyx and both were very good. They both cleared my nail psoriasis, but Cosentyx was overall better for me at clearing psoriasis in other parts of my body where Stelara failed to do so.

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