How to Treat Toenail Psoriasis

Written by kathleen blanchard, r.n.
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Toenail psoriasis can be difficult to treat. Changes that occur in the nails include thickening, splitting, changes in toenail colour and a pitting appearance. Appearance aside, toenail psoriasis is painful and can limit the person's ability to remain active. It occurs in 25 to 50 per cent of patients with psoriasis. The goal is to find a safe effective treatment with the help of your doctor. Several studies have been performed to find oral medications to help the problem, but few have been successful. Know the symptoms and prevalence of toenail psoriasis, and learn what treatments are available. Read on to learn how to treat toenail psoriasis.

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    Keep in mind that you will need an examination from your family doctor or podiatrist for a definite diagnosis of toenail psoriasis. Conditions that can be confused with toenail psoriasis include nail fungus, or abnormal growths such as benign or cancerous growths under the nail. Patients with existing psoriasis may not realise that psoriasis can indeed affect the toenails. It's also possible to experience toenail psoriasis without evidence of the disease elsewhere on your body.

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    Know that psoriasis affects approximately 2 per cent of the U.S. population. The skin lesions associated with psoriasis are the result of an abnormal immune system response. T cells (immunity enhancers) in the outer and inner layers of the skin (the dermis and epidermis) become overactivated, resulting in skin lesions. It is normal to experience psychological stress and some degree of social shyness. Psoriasis of the nails might be the only place lesions exist, again making a diagnosis important.

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    Studies show that effective treatments for psoriasis are still needed. Medications that are currently used to treat all forms of psoriasis include cyclosporine, methotrexate, and systemic retinoids in combination with phytotherapy and topical psoralens, a treatment process known as PUVA (Psoralen, UVA exposure). Calcipotriol, a Vitamin D derivative, can provide some relief. Triamcinolone acetonide suspension can improve the appearance of the nail. Steroids are commonly used by way of injection in and around the nail. Unfortunately, systemic treatment can cause side effects such as increased cholesterol levels, and greater susceptibility to skin cancer and other types of infection. These treatments don’t work for everyone.

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    In addition to medical therapy, it’s important to avoid trauma to the toenails. Pressure can cause splitting, and trauma to the nail beds. It’s important to keep your nail trimmed. Trauma can make the condition worse. Keep your nails as short as possible. Engage in excellent nail hygiene. Be careful not to injure the area under the nail beds during cleaning. Choose professional grade nail care utensils when cleaning under the nails. Soak your feet in warm water and file thickened nails to improve their appearance. Cut the nail straight across, focusing on small portions at a time. Consider a professional pedicure, or regular visits to a podiatrist. It’s best to avoid artificial nails because of reactions to glues and polish. Treat underlying conditions, such as nail fungus. Wear shoes that don’t put pressure on the nail beds.

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    Understand that the immune response associated with toenail psoriasis can be suppressed with the drug efalizumab, which was approved last year for psoriasis treatment, following a Phase III clinical trial. Phase IV studies show promise for the successful treatment of toenail psoriasis. Keep your options open by involving yourself in open communication and regular visits with your health care provider. Know that research is ongoing, with the recognition that treatment options for all forms of psoriasis are needed. The treatment of toenail psoriasis may take several approaches before individual success is noted.

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