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Nail Psoriasis

When to Seek Medical Care for Nail Problems

If you notice changes in your nails such as discoloration (white spots or yellowing areas) or pits or if your nails seem infected or are painful, see your doctor.

Exams and Tests for Nail Psoriasis

Your doctor may take a biopsy (a small sample) of the skin under your nail to determine if you have psoriasis of the nail.

Nail Psoriasis Treatment

At present, psoriasis of the nails does not have a cure. The goal of treatment is to improve the function and appearance of your nails. If your nails have a fungal infection, your doctor will prescribe an antifungal medication.

Home Remedies for Nail Psoriasis

In areas where your nail has loosened, gently trim the nail back to the skin where it is connected. This will allow medications to work better. All nail care must be very gentle. Vigorous nail care can cause psoriasis to flare. Attempt to avoid injuring nails so they don't loosen more or become infected.

 

Medical Treatment for Nail Psoriasis

Your doctor may recommend that part of your nail be removed, either chemically or surgically. Chemical removal of your nail involves putting an ointment on your nails for seven days. The nail comes off by itself with no bleeding.

Medications for Nail Psoriasis

Your doctor may prescribe any of the following medications for nail psoriasis:

  • Creams or ointments to rub on and around the nail, including steroid, topical vitamin A or D derivatives, or, occasionally, antifungal solutions may be needed if a fungus infection is present. However, delivery of medications to the nail area is difficult because of the barrier presented by the nail plate. Topical treatments (applied directly to the nail) may not be effective in all cases.
  • Steroids applied to the skin under your nail or injected under the nail
  • PUVA (This therapy is a combination of the prescription drug psoralen and exposure to ultraviolet light.)
  • Systemic therapy if you have both skin and arthritis symptoms (systemic therapy is medication that spreads throughout your body). It is often in pill or injectable form, including methotrexate tablets, and injectable Enbrel (etanercept), Humira (adalimumab), as well as infusible Remicade (infliximab).

Surgery for Nail Psoriasis

If other treatments don't work, a doctor can surgically remove the nail. The area is numbed with a local anesthetic before the nail is removed.

Preventing Nail Psoriasis

To prevent psoriasis of the nails, keep your nails dry and protect them from damage.

Nail Psoriasis Outlook

Nail psoriasis does not have a cure, but the treatments mentioned above may improve the appearance and function of your nails.

Multimedia

Media file 1: Anatomy of the nail, view from top.

Nail Psoriasis Illustration

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Media file 2: Anatomy of the nail, side view.

Nail Psoriasis Illustration

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Media file 3: Nail psoriasis with nail loosening. Image courtesy of Hon Pak, MD.

Nail Psoriasis Photo

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Media file 4: Nail psoriasis of the fingernails and toenails. Note discoloration. Image courtesy of Hon Pak, MD.
 

Nail Psoriasis Photo

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Media file 5: Nail psoriasis with pitting. Image courtesy of Hon Pak, MD.

Nail Psoriasis Photo

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Media file 6: Nail psoriasis with joint involvement.

Nail Psoriasis Photo

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Media file 7: Extensive psoriasis with nail and joint involvement.

Nail Psoriasis Photo

Media type: Photo
 

WebMD Medical Reference from eMedicineHealth

Reviewed by Debra Jaliman, MD on October 31, 2013
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