Nail psoriasis is a condition in which the immune system mistakenly attacks the nails, leading to changes such as pitting, ridges, thickening, and white or brown spots. These changes can affect one or several nails and may look similar to a fungal nail infection.
Although nail psoriasis has no cure, treatment can help improve nail appearance and control symptoms. Common options include medicated nail polishes, ointments with corticosteroids or vitamin D, and medications for more severe cases.
In addition to medical treatment, nail psoriasis can also be managed with proper nail care and diet. Keeping the nails clean and moisturized and eating foods rich in omega-3, such as salmon, flaxseed, and walnuts, may help reduce inflammation.
Main symptoms
The main symptoms of nail psoriasis are:
- Nail pitting, or small dents in the nails
- Ridged or uneven nails
- Deformed nails
- Brittle, peeling nails
- White or brown spots
- Thickened nails
- Nail separation, called onycholysis
- Bleeding
Symptoms of nail psoriasis can affect one or more nails and may look similar to fungal infections, such as nail fungus.
According to the National Psoriasis Foundation, nail changes such as crumbling should be evaluated by a dermatologist to confirm the diagnosis and find an appropriate treatment.
Confirming a diagnosis
Nail psoriasis is diagnosed by a dermatologist based on the appearance and characteristics of the nails.
In addition, to rule out a fungal nail infection, the doctor may recommend scraping the nail or collecting a small nail sample to be analyzed in a laboratory.
Treatment options
Treatment for nail psoriasis should be managed by a dermatologist, who will choose the best approach based on how many nails are involved, the person’s overall health, and how severe the symptoms are.
1. Nail polishes
Nail psoriasis can make the nails rough and fragile. Some medicated nail polishes may help improve their appearance by making them look smoother and stronger.
Some nail polishes may contain ingredients such as vitamin D or clobetasol, which can help repair the nail.
However, it is important to talk to a doctor before applying nail polish to nails affected by psoriasis, as not all nail polishes are helpful.
2. Ointments
In milder cases of nail psoriasis, a dermatologist may recommend ointments that contain ingredients such as vitamin A, vitamin D, corticosteroids, or immunosuppressants.
These ointments help reduce inflammation and support the nail as it regains its normal shape.
When nail lesions are more extensive or psoriasis also affects other areas, such as the palms of the hands, ointments may be used together with other medications.
3. Medications
Medications such as methotrexate, cyclosporine, retinoids, and corticosteroids are usually recommended when psoriasis affects other areas of the body or when local treatments, such as nail polishes or ointments, do not work.
In general, these medications reduce the activity of immune cells that are attacking the body, helping to relieve symptoms.
In more advanced cases of nail psoriasis, a doctor may recommend corticosteroid injections, which are usually given with local anesthesia. According to the American Academy of Dermatology, corticosteroid injections may help treat nail thickening, ridges, buildup under the nails, and nail separation caused by nail psoriasis.
People with more severe or widespread psoriasis may also need ongoing monitoring to adjust medication dose and duration.
4. Natural treatment
Some care measures can be done at home to help treat nail psoriasis, such as keeping the nails short and clean.
To clean the nails, use mild, antibacterial soaps. It is also important to avoid rough sponges or brushes with thick bristles, as these can cause injured nails to bleed.
It is also recommended to use nail clippers instead of scissors to reduce the risk of further injuring the nails. In addition, the nails should be moisturized with suitable products recommended by a doctor, as this can help prevent nails affected by psoriasis from becoming ingrown.
5. Diet
To help manage symptoms of nail psoriasis, it is best to limit foods that may increase inflammation, such as red meat, processed meats, canned foods, spicy peppers, and foods with artificial preservatives. Examples include sausage, hot dogs, and bacon.
It is also important to eat more fruits, vegetables, and foods rich in omega-3. These include flaxseed, salmon, tuna, walnuts, and chestnuts.