Psoriasis is a chronic skin disease characterised by red elevated patches on the skin along with some white and silvery scales. The skin may also appear shiny and sometimes such circumscribed elevations may contain pus (pustules) in severe cases. Psoriasis of the fingernails occurs in about 50 per cent of patients with psoriasis. Nail changes take place around the nail plate, nail bed, nail matrix and the skin at the base of the nail. Nail psoriasis may affect one or all fingernails at the same time. Symptoms include the following: salmon patch (a clear yellow-red nail discolouration) appears under the nail plate; nails may appear pitted due to loss of keratin cells (cells that make up the nail); appearance of beau lines (abnormal lines that appear from the sides of the nails rather than the root tip); thickening of the skin under the nail (subungual hyperkeratosis) that may lead to separation of nails on the nail bed(onycholysis); abnormal white areas (leukonychia); crumbling (onychodystrophy) of the nail plate, and thickening of the nail (onchomycosis). Treatments of these symptoms are dependent upon the site and severity of the condition. Read on to learn more about how to treat psoriasis of the fingernails.
- Skill level:
Things you need
- Topical creams--calcipotriene (Dovonex), topical corticosteroids and 5-fluorouracil cream
- Injection needle containing prescribed medication triamcinolone acetonide
- Prescription medication Psoralen
- Oral medications--ciclosporin, methotrexate and retinoids (Soriatane)
- Anti-fungal cream
- Tar bath oil and a large basin filled with warm water
- Clean and sterilised clippers and nail file
- Nail polish
- Artificial nails and glue
Apply some topical cream or ointment around the fingernails. Calcipotriol is a Vitamin D derivative that is otherwise known as calcipotriene (Dovonex) in the United States, and is found to be very effective in treating psoriasis. Apply it over the affected nail folds daily. Application of topical corticosteroids is also recommended. This method works best when nails are enclosed with a cellophane wrap that is applied at bedtime. Put some 5-fluorouracil cream on the nail matrix for six months. This may help improve pitting and subungual hyperkeratosis of the nails.
Go for an intralesional method. Injection of intralesional triamcinolone acetonide along the proximal nail folds of the nail matrix can be of help, but this method is painful.
Visit your doctor for proper instructions about PUVA treatment. PUVA, or photochemotherapy, is a type of treatment involving the use of Psoralen (P) and exposing the skin to UVA (long wave ultraviolet radiation). Prescription medication Psoralen can be applied in two ways: it can be painted over the affected area or it can be taken orally.
Ask your doctor about some helpful oral medications. Oral medications such as ciclosporin, methotrexate and retinoids (Soriatane) are the usual prescriptions for generalised psoriasis but may also be beneficial for nail psoriasis.
Consult with your doctor or surgeon if your case is qualified for a chemical or surgical avulsion therapy. This type of method is rarely advised and is most likely the last resort for severe cases. It involves removal of the entire nail or nails. Newly grown nails of the operated area may appear just as bad as it was, or maybe even worse, than what it looked like before the procedure.
Use some topical anti-fungal creams if fungal infection is present with nail psoriasis. Thickening of the nails (onchomycosis), caused by fungal infection, can be treated by systemic applications of anti-fungal agents. Some cases of nail psoriasis are made worse due to the presence of fungi infecting the already weakened nail areas. So it is important to treat fungal infection as well to decrease infection. But, it should be noted, that fungal treatment alone will not heal nail psoriasis.
Perform some home nail care to improve the appearance of your affected nails. Prepare a bottle of tar bath oil and a large basin filled with warm water. Take the cap of the tar bottle and fill the cap with oil and pour three caps worth into the warm water. Soak your fingers on the solution for 20 minutes, carefully pat them dry, and place some moisturising cream on your nails.
Keep your nails short. Constantly trim your affected fingernails to avoid further complications. Long psoriatic nails are more susceptible to tearing when the surface of the nail is rubbed on certain areas, which will only make matters worse. Observe extra care of your affected fingernails. If you are working with your hands, make sure to wear gloves for further protection.
Gently even the surface of your thick and pitted fingernails with a nail file and apply nail polish on it to ameliorate its appearance. Do it smoothly and be very extra careful to avoid further damage. You can also attach some artificial nails to make your nails look more appealing. Make sure that you are not allergic to the kind of glue you are using.
Tips and warnings
- Be very careful when you handle clippers or other instruments used for cleaning your nails. Remember that the areas are already fragile so try not to do it vigorously.
- Make sure that all your manicure sets are clean and well-sterilised before using it. Keep in mind that your affected nails are already vulnerable to infections so be extra wary.
- Avoid using corticosteroids for more than two weeks to prevent occurrence of side effects.
- Understand that 5-fluorouracil cream is an effective agent but may become destructive if used improperly. So make sure to follow the exact directions or instructions. This cream is not advisable for pregnant women.