Nail Psoriasis Signs, Symptoms and Treatment

Although nail psoriasis is a symptom of psoriasis, isolated nail psoriasis is also one serious issue of psoriasis. 70 to 80 percent of the people living with functional psoriasis arthritis have nail psoriasis. And 10 to 55 percent of the people affected with psoriasis have a prevalence of nail psoriasis. Only less than 5 percent of the people with no signs of any other psoriasis can have nail psoriasis. 

What does nail psoriasis look like? 

Nail Psoriasis Image

Nails appear in various recognizable signs such as discoloration, pit formation, hyperkeratosis, morbidity, and damage to the functioning of the nails also can occur. However, the reasons behind such changes in the nails are not so easily recognizable. They can be due to any disease activity, fungal activity, or even inflammatory damages in the body 

Nail structures and functions

Nail structure

Let’s dig into the parts of the nail. A fingernail is a nail bed, the cuticle, nail folds, the moon as part of the nail, and the matrix. The nails grow from the matrix. 

A fingernail in its healthy state protects the farthest bones of the hand bones also called digitals. The soft tissues around the nail and the fingertips are also kept safe by the nails. 

Touch and grip are facilitated by them. The units of nails also protect themselves from external invasion.

Any alteration from the healthy state and appearance is considered an issue of clinical significance. 

For instance, when a nail is pressed with an external force, the nail bed turns white. When the pressure on the nail bed is removed, the actual pink colour of the nail bed should be restored in less than two seconds. The delay in returning to the colour indicates certain dehydration or fluid imbalance in the body. This is called a blanch test. The manner of health that nails forecast also shows the history of various diseases infected. 

Nails painlessly detach from the nail bed, which is a medical condition called onycholysis. Usually, ring fingers get affected, sometimes others too at nail tips, and sides. Also, there’s another medical condition in which the nail growth piles up and hardens to form a claw or horn-like appearance, called onychogryphosis. In some fungal infections, the nails rarely loosen from the nail bed. Nail degeneration is another condition in which deterioration happens rapidly. 

Speaking About discoloration, the formation of mee’s lines which can be said as white lines horizontally across the nail can be noticed. Blue arrows and brown arrows are the names given for varied patterns of lines forming against the nail. Thinning of the nails, brittleness which leads to shedding of nails in layers, and the formation of grooves, and splits all happen with the discoloration. 

Signs and symptoms of nail psoriasis

Psoriatic finger nail

Nail psoriasis is one such clinical manifestation of the nails. It’s a chronic inflammatory condition of the nails. When psoriasis involves a nail bed or nail. matrix, nail psoriasis happens. It’s now a major concern for both the elderly and adults. In patients living with psoriasis above the age of 60 years, 28% have involvement with nail psoriasis. 

  • If you have psoriasis, you would inevitably have nail psoriasis too. The ones affected with psoriasis should be checked on their nail health regularly. 
  • It is not just a problem with nails but it’s a group of issues affecting each part of the nail or the nail units. 
  • All the hyperkeratosis, pits, loss of nails, etc all are only a unit of the nail. 
  • Unlike many signs, the nails show in an unhealthy condition. 
  • The nails show numerous signs such as discoloration into yellow, brown, and white colors, they may separate from the nail beds, or they may build up underneath the nails, and they crumble and tip off too. 
  • All these are visibly seen. Any noticeable change in the nail or any of these signs should be taken to a dermatologist. Whereas in elders or adults above 60 years of age identifying by mere physical examination can be difficult as they also undergo physiological changes with aging.
  • A dermatologist and a treatment help clear psoriasis and its severe effects on the nails. 
  • In people with no psoriasis history, nail psoriasis also can be a sign of psoriasis arthritis. 
  • People with plaque psoriasis also develop nail psoriasis which is a blue line discoloration and a black arrow which means a line of blood across the nail. 
  • Not every person shows nail psoriasis first, in general it begins years after the first psoriasis patch on the skim
  • Although the nail psoriasis clears slowly, the general preventive measures suggested by dermatologists should not be neglected.
  • The quality of life of the person with nail psoriasis gets tampered with. Alongside its long-term challenges, it leads to depression. 
Psoriatic toe nails

Treatments and management of nail psoriasis

The first line of treatment for mild nail psoriasis comes as a topical treatment. 

They will be given to be applied on the fingers in the form of foams, creams, nail lacquers, and solutions. The general combination involved a vitamin D analogue with a steroid. Topical steroids are always given along with other medications like combination therapy. 

Considering the nail matrix and nail bed involvement, topical agents are prescribed. As precise as no skin involvement, three to two nail involvement, and limited skin involvement are all taken care of. 

Calcipotriol creams, clobetasol propionate cream, are found to be effective vitamin D3 analogues. They are meant to reduce inflammation and regulate cell divisions. Tazarotene and secukinumab demonstrated high efficacy in the topical treatment of psoriatic nails. More importantly in the pitting, and loss of the nail areas.  

Topical calcineurin inhibitors kill the genes that cause the inflammatory effect. Cyclosporine and tacrolimus are most frequently used in this use. These have shown rapid improvement in the damaged nails.

Conventional systemic agents like methotrexate, acitretin, and fumaric acid are also effectively exploited. These agents are given as a maintenance treatment. 

Light and laser treatments for nail psoriasis.

Application of a Pulsed dye laser with a 595 nm wavelength and a more intense pulsed light with a wavelength of 550 nm is employed in treating nail psoriasis. Although this is done once every 3months. 

All the conventional systemic agents, biologics, and smallest molecules everything that goes into the treatment plan has to be prescribed placing the age, degree of infection, personal choices, and comorbidities all in perspective. 

Nail Psoriasis image

Few points to remember

  • The nail grows very slowly
  • Nail psoriasis treatments do not change the existing nail but impact the new nail developing the nail plate.
  • It may take almost one year to see the changes for fingernails to grow normally whereas toenails may take approximately two years.
  • You must be patient with the treatment.
  • Fingernails respond faster and better compared to toenails.

Read, Ayurvedic Treatment for Nail Psoriasis

References:

  1. https://www.sciencedirect.com/science/article/abs/pii/S0733863520301145
  2. https://www.sciencedirect.com/science/article/abs/pii/S0190962221013554
  3. https://pubmed.ncbi.nlm.nih.gov/32644686/
  4. https://www.sciencedirect.com/science/article/abs/pii/S0733863520301170
  5. https://www.emedicinehealth.com/nail_psoriasis/article_em.htm
  6. https://www.aad.org/public/diseases/psoriasis/treatment/genitals/nails
  7. https://en.wikipedia.org/wiki/Nail_(anatomy)

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