Nail Psoriasis: Causes, Symptoms, and How to Treat It

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Here at Allure, we think a lot about nails. The easiest ways to stop biting them; when to pierce them; how to paint them with a giant turkey for Thanksgiving. But as any dermatologist — or manicurist — will tell you, nail health is the most important factor when considering all 20 of your digits, far more than what shade of polish to use. If you’ve noticed discoloration or thickening in your nails, you may be dealing with nail psoriasis, a finger- and toenail-specific offshoot of the chronic inflammatory skin condition.

It’s possible to have nail psoriasis “without any prior signs of psoriasis on your skin,” says Dendy Engelman, MD, a board-certified dermatologist in New York City, but most patients who present with nail psoriasis have already dealt with psoriasis on the skin. The nail condition can affect people at any age, she says, though it’s most commonly found in adults.

Ahead, learn more about the ways psoriasis can have “nail involvement,” as dermatologists put it, and potential ways to treat the condition. As always, the most accurate diagnoses and treatment plans come from your own board-certified doctor. Get these more serious concerns checked, then come back to talk manicures.

Meet the Experts:

  • Dendy Engelman, MD, a board-certified dermatologist at Shafer Clinic in New York City.

  • Tracy Evans, MD, MPH, a board-certified dermatologist at Pacific Skin in Corte Madera and San Francisco, California.

  • Divya Shokeen, MD, a board-certified dermatologist at Ocean Skin and Vein Institute in Southern California.

In this story:

  • What causes nail psoriasis?

  • What are the symptoms of nail psoriasis?

  • How is nail psoriasis treated?

What causes nail psoriasis?

Just as skin psoriasis comes from “an overactive immune system,” Dr. Engelman explains that the nail version of the condition “occurs when the immune system mistakenly attacks the nail cells, leading to inflammation and other symptoms.” That immune system malfunction “disrupts the normal nail growth and maintenance cycle,” elaborates Divya Shokeen, M.D. a board-certified dermatologist in Southern California.

There likely isn’t one complete cause, but a combination of catalysts. According to Dr. Engelman, those may include genetic predisposition, autoimmune diseases, and environmental triggers, such as nail infections or injuries. Lifestyle factors including smoking and excessive alcohol consumption can also increase your risk of developing nail psoriasis, she says.

What are the symptoms of nail psoriasis?

First of all, keep in mind that nail psoriasis won’t necessarily show up on all 20 of your nails at once. According to Dr. Shokeen, the condition can impact as little as one nail on one finger, and as much as multiple nails on the hands or feet. “In severe cases, nail psoriasis can cause significant discomfort, pain, and functional limitations,” she says.

You may also notice one of a variety of symptoms, Dr. Shokeen says: discoloration that can turn your nails yellow or brownish; “pitting,” which entails “small depressions or dents” on the nail; and “brittle, fragile nails that may break easily or crumble.” Nail psoriasis can also include thickened nails — if you notice nails are so thick that they are difficult to trim, that could be a sign — and “onycholysis, a separation of the nail plate from the nail bed, resulting in white discoloration and an abnormal appearance.”

How is nail psoriasis treated?

The good news (for skin psoriasis patients, at least) is that you can treat two birds with one stone. “Overall treatment for psoriasis, including oral and injectable medications, can help nail involvement,” says Tracy Evans, M.D., a board-certified dermatologist in Corte Madera and San Francisco, California. To treat nail psoriasis specifically, she says injections of low-dose steroids are often given near the affected nail. Depending on the case, Dr. Engelman may recommend retinoids to “address nail separation and discoloration” and vitamin D derivatives that fight against buildup under the nail. Once you find a treatment that works for you — and stick to it with consistency — it can take six months or more to see an improvement, Dr. Engelman says.

It’s never fun to get a new diagnosis, or to learn that a condition that affects one area of the body has spread to another. But once you have psoriasis-free fingernails and toenails (in addition to the satisfaction you’ll get from nail health), there’s a pretty great pot of gold at the end of the rainbow. Or in this case, a mani-pedi at the end of the treatment cycle.

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Originally Appeared on Allure