Summary about Disease
Nail psoriasis is a form of psoriasis that specifically affects the nails, causing changes in their appearance and texture. It can affect fingernails, toenails, or both. It is often associated with psoriasis on other parts of the body but can also occur independently.
Symptoms
Symptoms of nail psoriasis can vary in severity and may include:
Pitting: Small depressions or pits on the nail surface.
Onycholysis: Separation of the nail from the nail bed, usually starting at the tip or sides.
Oil Drop Sign (Oil Spots): Yellowish-red or brownish discoloration visible through the nail, resembling a drop of oil under the nail plate.
Subungual Hyperkeratosis: Buildup of chalky material under the nail, causing it to lift.
Transverse Grooves (Beau's Lines): Horizontal ridges or lines across the nail.
Splinter Hemorrhages: Small, dark lines appearing as splinters under the nail.
Nail Thickening: The nail plate becomes thicker and more distorted.
Crumbling Nails: Nails become brittle and easily crumble or break.
Discoloration: Yellowing, browning, or white patches on the nail.
Causes
Nail psoriasis, like other forms of psoriasis, is an autoimmune disorder. The exact cause is not fully understood, but it's believed to involve a combination of:
Genetics: A family history of psoriasis increases the risk.
Immune System Dysfunction: The immune system mistakenly attacks healthy skin and nail cells.
Environmental Triggers: Certain factors can trigger or worsen psoriasis, such as stress, infections, skin injuries, and certain medications.
Medicine Used
Treatment options for nail psoriasis include:
Topical Medications: Corticosteroids, vitamin D analogs (calcipotriol), tazarotene (a retinoid), and antifungals (if secondary fungal infection is present) applied directly to the nails and surrounding skin.
Intralesional Corticosteroid Injections: Corticosteroids injected directly into the nail matrix (the area where the nail grows) to reduce inflammation.
Oral Medications: Systemic treatments for psoriasis, such as methotrexate, cyclosporine, acitretin, apremilast, and biologics (e.g., TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors), may be prescribed for more severe cases or when other areas of the body are also affected.
Phototherapy: Exposure to ultraviolet (UV) light, either PUVA (psoralen plus UVA) or UVB, may be used to treat nail psoriasis.
Laser Therapy: Certain laser treatments may help reduce inflammation and improve nail appearance.
Other: Prescription nail lacquers may be prescribed. Note: *Always consult with a doctor to determine the most appropriate treatment plan for your specific condition.*
Is Communicable
No, nail psoriasis is not communicable. It is an autoimmune condition and cannot be spread from person to person.
Precautions
Keep nails short and well-trimmed: This reduces the risk of injury and infection.
Avoid nail trauma: Protect nails from injury, such as hitting or picking.
Keep nails clean and dry: Prevent fungal infections by maintaining good hygiene.
Moisturize nails and cuticles: Use a moisturizing cream or oil to keep nails hydrated and prevent cracking.
Avoid harsh chemicals: Wear gloves when using cleaning products or other chemicals that can irritate the nails.
Avoid artificial nails and excessive manicures: These can damage the nails and worsen psoriasis.
Manage stress: Stress can trigger psoriasis flare-ups, so practice stress-reducing techniques.
How long does an outbreak last?
The duration of a nail psoriasis outbreak can vary greatly. It can last for weeks, months, or even years. Nail psoriasis is often a chronic condition with periods of improvement and worsening. Treatment can help manage symptoms and reduce the duration and severity of outbreaks. It can take a very long time to see improvement. A full fingernail can take about 6 months to grow out completely, and a toenail can take 12-18 months to grow out completely.
How is it diagnosed?
Nail psoriasis is typically diagnosed through:
Physical Examination: A doctor will examine the nails and surrounding skin for characteristic signs of psoriasis.
Medical History: The doctor will ask about your medical history, including any personal or family history of psoriasis.
Nail Clipping or Biopsy (rarely): In some cases, a nail clipping or biopsy may be taken to rule out other conditions, such as fungal infections or nail tumors.
Ruling out other conditions: Other conditions that can cause similar nail symptoms include onychomycosis (fungal infection of the nail) and lichen planus.
Timeline of Symptoms
The timeline of nail psoriasis symptoms can vary significantly from person to person. It often follows a chronic, relapsing-remitting course.
Initial Stage: Subtle changes may appear, such as minor pitting or slight discoloration. These changes can be gradual and easily overlooked.
Progression: Over time, symptoms may become more pronounced, with increased pitting, nail thickening, onycholysis, and oil spots developing.
Flare-Ups: Periods of increased disease activity, triggered by factors like stress, infection, or injury, can lead to a rapid worsening of symptoms.
Remission: Periods of improvement may occur, either spontaneously or with treatment, during which symptoms lessen or disappear.
Chronic Stage: For some individuals, nail psoriasis may become a chronic condition with persistent symptoms and occasional flare-ups.
Important Considerations
Nail psoriasis can significantly impact quality of life: The cosmetic appearance of affected nails can lead to self-consciousness and social anxiety.
Nail psoriasis can be difficult to treat: Nail psoriasis can be resistant to treatment, and complete resolution may not always be possible.
Treatment adherence is important: Following the prescribed treatment plan consistently is crucial for managing symptoms and preventing flare-ups.
Underlying Psoriasis: Nail psoriasis may be a sign of underlying psoriatic disease. It is important to be screened for psoriatic arthritis.
Early diagnosis and treatment are essential: Early intervention can help prevent the condition from progressing and causing further damage to the nails.
Long-term management: Nail psoriasis often requires ongoing management, even during periods of remission, to prevent recurrence.
Consult a dermatologist: It is important to seek the advice of a dermatologist for diagnosis and treatment of nail psoriasis.