Psoriasis of the Nails
Symptoms
Nail psoriasis can cause pitting (small depressions) on the nail surface, discoloration, thickening, and separation from the nail bed (onycholysis). The nails may appear yellow, brown, or red under the plate. They can become brittle and distorted in shape. In some cases, the nails crumble or develop horizontal ridges. The surrounding skin may also be inflamed or scaly. Symptoms often accompany skin psoriasis but may occur independently. Nail involvement can cause functional impairment or pain. Patients often feel self-conscious due to appearance.
Cause
Psoriasis of the nails results from inflammation in the nail matrix and bed, triggered by an overactive immune response. It is a form of autoimmune disease and frequently occurs in individuals with plaque psoriasis or psoriatic arthritis. Genetic predisposition plays a strong role. Environmental factors like stress, trauma (Koebner phenomenon), or infections may contribute. Nail psoriasis is not contagious. It can affect fingernails, toenails, or both. The severity varies widely among individuals.
Treatment
Topical treatments such as corticosteroids, vitamin D analogs, or tazarotene can help mild nail involvement. Intralesional steroid injections may be used for more severe cases. For widespread or resistant nail psoriasis, systemic treatments like methotrexate, cyclosporine, or biologics (e.g., TNF or IL inhibitors) may be needed. Nail care is important—avoid trauma, use gentle nail grooming, and protect nails from excessive moisture. Improvement is slow due to the nail’s slow growth rate. Laser therapy or phototherapy may be used in select cases. Combination approaches often yield the best results.
Dr. Beth Schulz-Butulis
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