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Nail Care and PsA

Medically Reviewed by Debra Jaliman, MD on July 13, 2021

If you have psoriatic arthritis (PsA), your nails are probably affected. Psoriasis is a skin disease, and nails are part of your skin, so it makes sense that you’d see changes there. But you don’t have to put up with symptoms. Here’s what you need to know.

PsA and Your Nails

Experts aren’t sure why, but PsA usually affects your fingernails more than your toenails. You might notice these changes:

Pitting. You may start to see small dents in your nails. There may be one or several of them.

Discoloration. Your nails might start to turn yellow or brown.

Subungual hyperkeratosis. This happens when a chalky substance builds up under your nails. The nail might become raised and tender, especially if you press on it. If this happens in your toenails, it might be uncomfortable to wear shoes because of the pressure.

Onycholysis. This is when your nail separates from the nail bed. You may see a white or yellowish patch at the tip that goes down to your cuticle, or the base of the nail. Bacteria might grow in the area between your nail and nail bed. This could turn nails dark green or lead to infection.

Onychomycosis. A fungal infection could cause your nails to thicken. Some people with nail psoriasis also have a fungal infection that worsens symptoms.

You might also see vertical ridges on your nails or reddish marks under them. These are called splinter hemorrhages. They happen when tiny blood vessels burst.

Treatment

Your doctor may suggest topical medications you put on your nails, like:

  • Corticosteroids
  • Calcipotriol
  • Tazarotene

If you need something stronger, they may recommend:

  • Corticosteroid shots
  • Laser treatment
  • PUVA, a combo of medication called psoralen and UVA rays

Psoriasis medications that may help include:

Caring for Your Nails

Follow these tips to keep your nails as healthy as possible:

Don’t bite or pick. This can injure your skin or lead to infection, which could worsen symptoms. And avoid scraping the buildup from under your nails. This can loosen them and also raises your risk of infection. The buildup will go away after treatment. Try soaking your fingers in soapy, warm water to get rid of it.

Watch what you wear. Stay away from shoes that rub your toes. You may want to go up a size to avoid this. And make sure they’re dry and clean. Dirty shoes can lead to fungal or bacterial infections.

Use gentle products. Stick to nail polish and nail polish removers that don’t have harsh chemicals. Some of these gentle products may have a label that says “8-free.” Avoid parabens, formaldehyde, and acetone.

Wear gloves. If you’re working around the house or out in the yard, put on gloves to protect your nails. Wear cotton gloves under your vinyl or nitrile gloves for another layer of protection if you’re washing dishes, the car, or anything else involving water.

Keep it short. Trimming your toenails and fingernails makes it less likely they’ll start to lift off the nail bed. It’ll also help you avoid buildup under the nails.

Stay away from artificial nails. Fake nails raise the risk of your nails separating from the nail bed. Hide nail pitting with buffing and polish instead. But be sure to leave your cuticles alone. Cutting or pushing them back can harm your skin or lead to infection.

Block moisture. Put petroleum jelly under your nails in the morning to stop water from building up.

Moisturize. You don’t want water sitting under your nails, but it’s important to lock in moisture elsewhere. Use a thick cream or ointment after bathing or washing your hands. Ask your doctor if you’re not sure what to use.

Be patient. It’s important to give your nails time to get better. Your toenails in particular grow slowly. It could take 6 months to a year to see healthy changes.

Show Sources

SOURCES:

Reumatologia: “Nail involvement in psoriatic arthritis.”

The Psoriasis and Psoriatic Arthritis Alliance: “Psoriasis in the nails.”

National Psoriasis Foundation: “What Your Nails Can Tell Your Doctor About PsA.”

American Academy of Dermatology Association: “What Is Nail Psoriasis, And How Can I Treat It?” “7 Nail-Care Tips That Can Reduce Nail Psoriasis.”

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