Nail psoriasis: symptoms, treatment and nail care

Psoriasis UK says psoriasis is unique to each person, so finding a treatment that works can be a process of trial and error. Because hands and feet are used so often, and nails grow very slowly, nail psoriasis can be quite difficult to treat. It says nail psoriasis is mostly treated with topical treatments. Sometimes nail psoriasis can go away by itself.

The options it describes are:

• Steroid-based treatments, which are likely to be offered and can be useful but are not suitable for long-term use. A moderately potent steroid tape (Haelan) is available on prescription and is often used because it can be cut to size and wrapped around the nail.

• Vitamin D-based treatments, applied to the affected area, with the finger then wrapped or covered to help absorption. This should not be done with a steroid treatment.

• Topical retinoids applied around and under the nails at night.

• Antifungal cream, occasionally, if a fungal infection is also present.

• Ultraviolet light therapy, systemic or biologic treatments, which are not likely to be prescribed for nail psoriasis alone but may improve the nails when used to treat the rest of a person's psoriasis. Any nail improvement may lag behind the skin by a few months.

Psoriasis UK says psoriasis can make nails grow more quickly and can change their appearance. It can range from mild to severe. Any of the following may suggest nail psoriasis:

• loss of the nail's usual healthy look, shape and feel

• discolouration of the nail

• small dents in the nail surface (pitting)

• nails that split or crumble easily

• thickening of the nail, or thickening of the skin below the nail

• nails that lift or detach from the nail bed (onycholysis)

No. Psoriasis UK says nail psoriasis is not just a cosmetic problem and should be appropriately treated by a healthcare professional such as a doctor or nurse. In moderate to severe cases it can be painful and make using the hands and feet difficult.

Hands and feet are easily seen, and people may find the changes distressing and try to hide them or avoid situations in which they can be seen. If it is affecting your confidence or daily life, tell your GP or dermatology team, because that is part of what treatment is for.

The NHS says psoriasis is caused by the skin making more skin cells than usual, that it is not known why or how this happens, and that it is thought to be caused by a problem with the immune system. You are more likely to have it if a member of your family has psoriasis.

The NHS lists triggers that can make psoriasis worse or cause a flare-up: stress, drinking alcohol or smoking, living with obesity, being pregnant, certain medicines, infections such as strep A and HIV, cuts, scratches or grazes on the skin, and sunlight. Psoriasis UK says damage and injury to the nails could worsen existing nail psoriasis or trigger it on currently unaffected nails.

The NHS says psoriasis is not contagious, so you cannot catch it or spread it.

The two can look alike, and Psoriasis UK says nail psoriasis is easy to misdiagnose as a fungal infection. The NHS says a fungal nail infection usually affects the toenails, usually starts at the edge of the nail and can make the nail brittle, crumbly, thicker and white or yellow. A GP may take a nail sample to find out what type of infection you have before giving antifungal tablets.

Psoriasis UK says the main general advice is to avoid damage and injury to the nails. Tips from the charity's members, enquirers and staff include:

• Do not damage the skin around the nail, for example by picking at or pushing back the cuticle during manicuring.

• Keep the nail and surrounding area dry, drying each nail separately with tissues.

• Apply any cream sparingly and wipe off the excess; a lotion may be easier to use.

• Use nail clippers rather than scissors, and trim the corners carefully so they do not grow into the flesh.

• Keep the nails short, because a long nail catches easily.

• Varnish or gently applied stick-on nails can hide distortion; avoid techniques that damage the cuticle or nail bed, as semi-permanent nails and gel fillers may stop treatment reaching the area.

• Keep nails clean, because bacteria can collect under them and cause infection.

See a GP if you have symptoms of psoriasis, your treatment is not working or is causing side effects, or you have joint pain, stiffness and swelling that keeps coming back. The NHS says psoriatic arthritis can cause nail changes such as colour change or tiny dents and pits, swollen fingers or toes, and joint symptoms that are worse first thing in the morning.

If you have psoriasis and your skin quickly turns red and you develop pus-filled white bumps that join together, or pus-filled red scaly bumps on the tips of your fingers or toes, the NHS says to call 999 or go to A&E.

On the NHS, a GP or practice nurse can start topical treatment and refer you to a dermatologist if nail psoriasis is severe or does not respond. Some people see a private dermatologist for faster review. Because nail psoriasis responds slowly, ask what improvement to expect and when your treatment will be reviewed.