Psoriasis is a chronic skin disease which can cause significant impairment in quality of life of a person. At least half of the patients suffering from skin psoriasis may have incidence of nail involvement. Sometimes nail psoriasis may solely occur without the skin lesions. Nail psoriasis can limit patient’s daily activity due to associated pain besides being a big aesthetic concern.
The disease can affect fingernails as well as toenails. Psoriasis of nail can cause several changes such as pitted spots on the surface, separation of nail plate from the nail bed, secondary fungal infection and in severe cases complete removal of nail.
Although there are several options of treating psoriasis, management of nail psoriasis is a challenging task particularly if psoriasis is limited only to the nails. Slow growth of nail and reduced penetration of topical ointment are main factors contributing difficulty in treating this condition. However, to an extent modern day treatment is found to be effective in dealing with nail psoriasis.
What Causes Nail Psoriasis?
Psoriasis is mainly a skin disease which can also affect other parts of body such as the nail and joints. The exact cause of psoriasis is not known, but it is believed to be an auto immune disease.Psoriasis also has hereditary tendency. If a person whose parent or sibling has a history of psoriasis, he may be having 25% chances of suffering from psoriasis. Psoriasis is also known to have environmental implications.
Nail psoriasis is predominantly secondary to skin psoriasis and psoriatic arthritis. At least 50 percent of patients who suffer from psoriasis are susceptible to develop psoriasis of nails. In people suffering from psoriatic arthritis, the ratio is even much more.
Nail psoriasis also depends on the severity of psoriasis. If the condition is severe, the chances of nail psoriasis are increased. Psoriasis can occur at any age, but it is more common in younger age group with incidence slightly higher in males than females. The disease can occur in all races.
Signs And Symptoms Of Nail Psoriasis
Since the nail is made up of many structures, the signs and symptoms of nail psoriasis may have distinct features according to the involvement of nail structures. Both fingernails and toe nails can be affected.
Nail pitting is one of the common symptoms in most cases of nail psoriasis. The surface of nail is marked with tiny pits. In the beginning there are few pits, but gradually the whole nail gets pitted.
When the nail bed is affected, it causes a condition called onycholysis. In this condition, the nail is separated from skin beneath it. In the beginning, the nail turns white at the tip, but gradually the patch becomes larger and spreads to the base of the nail. Splinter hemorrhages develop which resemble like a drop of oil under the nail.
In severe cases of nail psoriasis, a chalk like material forms under the nail. As a result, the nail gets raised. It is a painful condition. This condition is called subungual hyperkeratosis.
Psoriatic nail can often cause secondary fungal nail infection in which the nail can result in change of color and thickening of nail.
Treatment Options For Nail Psoriasis
Nail psoriasis has no absolute cure. Often mild cases may significantly improve and the nail returns to its normal look and feel. However, in majority of cases treatment may be necessary as patient is extremely distressed with the unsightly appearance, besides the pain.
There are several treatment algorithms available. But Till now there is no single option that has proved to be the best of all. Management becomes a great challenge when only nails are involved.
- Psoriatic nail disease can also be triggered by traumatic injury to nail while biting nails, manicure, trimming cuticle wearing tight fitting shoes etc. Therefore general care of nail is of prime importance. The nail should be cut short, and the hands should be cleaned properly. Any form of trauma to the nail should be prevented.
- Topical therapy with steroid ointments is proved beneficial to certain extent.
- Patient is often prescribed anti fungal treatment as in many cases it is an associated problem.
- Steroid injection is recommended by many physicians in severe nail psoriasis. However, it is painful therapy.
- A combination of topical therapy with Vitamin D 3 analogue calcipotriol and corticosteroid has proved beneficial in treating the condition.
- Psoralen and PUVA therapy are also used in some cases for improvement of psoriasis of nails.
- Laser and Phototherapy also play a significant role in improvement of nail psoriasis.