Nail Psoriasis: What Causes It and Can It Go Away?

Medically Reviewed By Clare Wightman MS, PAC
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Psoriasis may involve the nails. When this happens, your immune system affects the skin at the base of or under your nail. This causes an atypical appearance and irregular growth of the nail. Psoriasis is an immune-mediated disease, which means it relates to atypical immune system activity. In psoriasis, this causes skin cells to rapidly turn over, resulting in a buildup of old skin cells. Psoriasis can also affect other organ systems, such as the joints.

Psoriasis is a chronic condition, so it can remain stable for many years and flare following exposure to triggers, according to the National Psoriasis Foundation (NPF). Many treatment options can help you reduce symptoms and improve your quality of life.

Read on to learn more about nail psoriasis, including its causes, medical treatment options, and home remedies and care tips.

What is nail psoriasis?

A person wearing gardening gloves
STUDIO TAURUS/Stocksy United

The following facts on nail psoriasis are from the American Academy of Dermatology (AAD).

Fast facts on nail psoriasis:

  • Nail psoriasis can affect some or all of your fingernails and toenails.
  • Most people who have psoriasis develop nail psoriasis.
  • Nail psoriasis can occur at any time. In fact, some people develop nail involvement more than 10 years after the diagnosis of skin psoriasis.
  • Treatment can take time before it is effective.

Nail psoriasis can have significant effects on a person’s quality of life, according to a 2021 research review. This may be because the nails are especially visible and people use their hands very regularly in day-to-day life, research from 2022 suggests.

What does nail psoriasis look like?

Nail involvement in psoriasis will differ depending on where the psoriatic inflammation is. It can be at the nail base, cuticle, or nail bed).

Some signs and symptoms of possible nail psoriasis include:

  • nail pitting or dents
  • thickening under the nail
  • nail separation from the nail bed
  • oil drop discoloration, which refers to a circular discoloration on the pinky nail
  • crumbly nail plate
  • white nails
  • lines under the nail, called splinter hemorrhages

Can nail psoriasis go away?

Treatment varies widely for nail psoriasis, according to the AAD. It depends on how much psoriasis affects the nails, along with the severity of skin and joint involvement.

Nails affected with psoriasis tend to be difficult to treat and often need a systemic medication. People who have skin psoriasis will notice their skin improving long before the appearance of their nails. This is because the nails take months to grow out, according to the Psoriasis and Psoriatic Arthritis Alliance (PAPAA).

Most systemic medications for psoriasis work by decreasing the immune response in the skin and joints, as well as around and under the nails. This means some of the symptoms should improve before you see typical nail growth, suggests the 2021 review mentioned earlier.

Why does nail psoriasis happen?

Psoriasis is a common condition, affecting up to 3% of the population of the United States, according to 2015 research. It is inflammatory and can affect the skin, nails, and joints.

With nail involvement, the inflammation occurs on the nail bed, nail matrix where the nail starts to grow, or both. This leads to atypical nail growth, per 2017 research.

Experts do not know why some people experience nail symptoms with psoriasis and others do not, according to the PAPAA. Repeated trauma to the nails can trigger flare-ups of nail psoriasis, 2022 research suggests.

Nail psoriasis may also be a sign of psoriatic arthritis, according to the NPF.

Learn more about the causes of psoriasis.

How do doctors diagnose nail psoriasis?

Clinicians will ask you about your medical history — particularly, whether you have a diagnosis or symptoms of psoriasis. They will also ask about which symptoms you have noticed and any medications you take.

They may then carry out a close physical exam to evaluate the signs and symptoms on and around the nails.

Many people with nail psoriasis already have another form of psoriasis. It affects around 50% of people with another type of psoriasis and is particularly common in people with plaque psoriasis. Around 80% of people with psoriatic arthritis will also experience nail psoriasis.

If a doctor is unsure whether your symptoms resulted from a fungal infection, such as onychomycosis, they may order infection testing using a nail clipping or scraping.

Learn more about the diagnosis process for psoriasis.

How do doctors treat nail psoriasis?

Medical treatment for nail psoriasis can depend on its severity and nail and joint involvement.

Treatment for mild nail psoriasis

If the condition affects only one or two nails and is not causing you significant symptoms, your doctor may recommend topical medication in the form of creams, gels, or ointments, according to the 2021 research review mentioned earlier.

These medications can firstly involve topical corticosteroids and vitamin D analogs. Topical tacrolimus and topical tazarotene are the second-line therapy.

If topical treatment is not effective on its own, doctors may recommend local steroid or methotrexate injections. These can be very painful, especially around the fingernails.

Sometimes, doctors will recommend light or laser therapy too. This can involve a clinician applying pulses of UV light onto the affected area.

Some people have seen success with topical treatments along with IPL, a type of laser therapy.

Learn more about the different severities of psoriasis.

Treatment for moderate to severe nail psoriasis

If your nail psoriasis is severe, affects more than three nails, or causes significant symptoms such as joint disease, healthcare professionals may classify it as moderate or severe.

In this case, doctors may recommend biologic therapies, the 2021 research review suggests. These can be very effective but expensive.

Common biologic treatments for psoriasis include:

  • eternacept
  • adalimumab (infliximab)
  • TNF alpha inhibitors
  • ustekinumab
  • secukinumab
  • ixekizumab

Learn about how to keep up with new psoriasis treatments.

Are there home remedies for nail psoriasis?

The 2021 research review mentioned some successful results involving the application of Indigo naturalist extract in oil, sometimes known as Lindioil.

In one 2015 study mentioned by the researchers, participants applied 1–2 drops of Lindioil to the fingernails of one hand and applied calcipotriol to the other hand twice daily for 24 weeks. Results showed the positive effects of Lindioil, though further studies are needed to confirm this.

Talk with your doctor before trying any home remedies for nail psoriasis. They may recommend safer and more effective homecare options in combination with medical treatment.

Learn more about home remedies for psoriasis.

How can I care for my nails with psoriasis?

Some tips from the NPF for caring for your nail psoriasis at home include:

  • Keep nails as short as possible. Loose nails can continue to get injured if they rub against surfaces.
  • Wear gloves while working with your hands to protect your nails from damage, which can worsen your symptoms.
  • Take care to treat the affected nails gently. Do not clip or push back your cuticles.
  • If a nail is lifting, do not aggressively clean under the nail tip. This can worsen the lifting.

What can trigger nail psoriasis?

Trauma to the nail is a common trigger of nail psoriasis. Clipping or pushing back your cuticles can cause a flare-up of psoriasis. Injury to the nail bed from loose nails can also trigger nail psoriasis.

The NPF recommends wearing gloves during manual labor to avoid trauma to the fingers and nails.

Continuing your treatment plan and following your doctor’s instructions as closely as possible will make your treatment as effective as possible. You may need to work with your doctor to try different combinations of treatments to find the best one for you.

Stopping treatment can cause your symptoms to return or worsen.

Summary

Nail psoriasis is a common type of psoriasis that often affects people with other types of psoriasis, such as plaque psoriasis or psoriatic arthritis.

Nail psoriasis occurs when the immune system causes inflammation at the base of the nail or under the nail, which results in pitting, crumbling, discoloration, and lifting.

Many treatment options for nail psoriasis are available, including topical creams, oral medications, and light therapy. You can also make some lifestyle adjustments, such as wearing gloves during manual tasks, to avoid damaging the nail and triggering symptoms.

People who have nail psoriasis often have joint involvement too. If you start to notice any painful or swollen joints, see your doctor. Psoriasis can eat away at the joints and cause permanent structural changes.

Since nails take a long time to grow, patience is important when waiting for the results of medications.

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Medical Reviewer: Clare Wightman MS, PAC
Last Review Date: 2022 Sep 27
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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