Symptoms--Nail Changes

Reviewed by: HU Medical Review Board | Last reviewed: July 2016.

What kinds of nail changes are linked to psoriasis?

Psoriasis, a chronic autoimmune disorder, is linked to various kinds of changes that can happen to the nails of the fingers and toes. This type of nail disease is known as psoriatic nail dystrophy.  

Nail changes can affect all or part of one or more of the nails, but most commonly occur on the fingernails. Some people, but not all, also have symptoms of plaque psoriasis on their hands, finger, feet, or toes. People who have psoriatic nail changes may also have plaque psoriasis and/or psoriatic arthritis at the same time. In fact, nail changes are often an early warning sign that someone with psoriasis may also develop psoriatic arthritis.

Nail psoriasis can cause many different changes to the nails. It can make the nail grow faster or become thicker. Parts of the nail might turn a white, yellow, brown, or yellowish-red color.

Pitting is a common nail change, which leaves small indentations on the surface of the nail. Lines or ridges can also appear on the nail. Some people may have nails that weaken, split, or crumble apart. Scaling between the nail and the nail bed can cause the nail to lift up and separate from its bed2.

These types of nail changes can cause soreness and discomfort, as well as making it difficult to do things like picking up small objects, fastening buttons, or tying shoes. Nail psoriasis can also cause people to be embarrassed or self-conscious while out in public, especially in situations where the nails cannot easily be hidden from view2.

What causes psoriatic nail changes?

Like other types of psoriasis, psoriatic nail disease is probably caused by several different factors related to the person’s family history, immune system, and environment2. People with psoriasis have overactive immune systems that trigger too much inflammation when it is not needed. This, in turn, causes too many skin and nail cells to be produced, which lead to nail changes of many kinds. Trauma or injury to the nail can also cause a person to develop nail psoriasis, or trigger a flare-up3.

How common are nail changes among people with psoriasis?

Over half of people with plaque psoriasis have symptoms that affect their nails in some way, and people with psoriasis have an estimated lifetime incidence of nail involvement 80-90%1. About 80% of people with psoriatic arthritis will experience nail changes. Nail psoriasis is rare in people who do not have another form of psoriasis: only around 5-10% of people with nail psoriasis do not have symptoms on the skin or have affected joints1. Nail changes affect people of all ages, genders, and ethnicities at roughly equal rates.

How are nail changes treated?

Nail changes due to psoriasis can be difficult to treat because it can take months or years for treatments to have an effect1. It can be difficult for topical medicines to penetrate the nail and reach the nail bed and growth plate, which are usually the areas most affected by the disease2. Despite the length of treatment, topical medicines can be effective for mild and moderate nail changes. Topical medicines include1:

More severe nail changes may need treatment with injectable medications or phototherapy1. Systemic medications and biologic therapies that affect the entire immune system can reduce inflammation and the nail changes it causes3.

Tips for living with nail changes

Some tips that may be helpful for people dealing with psoriatic nail changes3:

  • Avoid trauma or injury to the nail of any kind
  • Avoid cutting or damaging the cuticles and skin around the nails
  • Keep the folds around each nail as clean and dry as possible
  • Keep nails as short as possible, using clippers instead of scissors to avoid ingrown nails

Using nail polish or artificial nails to mask nail changes is generally not harmful. However, it is best to avoid things like gel nails, which can prevent topical treatments from reaching the natural nails4.

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