Psoriasis affects about one person in 50, says the National Psoriasis Foundation (NPF). About 7.5 million Americans have this chronic, inflammatory, non-contagious skin disease and about half of them have nail psoriasis, says the NPF. The NPF and dermatologist Dr. Richard Langley, author of "Psoriasis: Everything You Need to Know," say the figure is much higher for patients with psoriatic arthritis as well as psoriasis.
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Psoriasis patients will notice either shallow or deep holes in their finger nails or toe nails. Langley says this is the most common sign of nail psoriasis. The pits are depressions, or dents, less than 1mm across. They look like pin holes and may appear on all nails or just some.
Deformed or thickened nails, changes from the normal shape, roughness, grooving, or depressions, may all indicate nail psoriasis, says Langley. Dermatologists call nail-thickening because of psoriasis hyperkeratosis.
Physicians call the nail separating and lifting away from the nail bed onycholysis. Langley says it usually begins at the edge or end of the nail. The symptoms may spread back under the nail until the nail pulls away completely from the nail bed.
Psoriasis-affected nails can develop a yellow-brown tinge that may affect the whole nail.
"The discolouration can also occur in only one or a few localised areas, in a spot-like manner, and resemble an oil droplet," says Langley.
Thickened nails can also result from a fungal infection called onychomycosis, says the NPF. Langley says physicians should treat fungal infections immediately because they can worsen any nail psoriasis that might be present.
Doctors ensure a correct diagnosis (either of psoriasis or fungal infection) by taking nail clippings and making a fungal culture. When physicians confirm a fungal infection they will treat the symptoms with oral anti-fungals, says Langley.
Nail Psoriasis alone
Some patients may have nail psoriasis with no psoriasis symptoms on the rest of their bodies, says Langley.
Nail psoriasis affects the nail when it is forming. The NPF says this makes it challenging to treat. Topical medicines do not easily penetrate the nail bed and they are not as effective as elsewhere on the body. Physicians inject corticosteroids into the nail bed, says the NPF, but the results vary. Patients may consider cosmetic repairs such as nail polish and artificial nails.
Langley says treatment results are often disappointing for both patients and dermatologists. He warns patients they might need prolonged treatment before they see an improvement. Topical treatments are generally ineffective, but systemic medications (either oral or injected) can improve nail psoriasis, he says. When systemics like methotrexate and cyclosporine start showing results in other parts of the body, nail psoriasis generally clears up too, he says.
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