Nail Psoriasis: Symptoms, Treatments, and Nail Care Tips

The Hidden Struggle of Nail Psoriasis

Imagine looking down at your hands and seeing nails that are thick, discolored, and crumbling at the edges. They catch on fabric, break easily, or even separate from the nail bed entirely. For many with nail psoriasis, this isn’t just a cosmetic issue—it’s painful, frustrating, and a constant reminder of an autoimmune condition that affects both confidence and daily life.

Nail psoriasis is more than just a surface-level problem. It affects nearly 50% of people with psoriasis and up to 80% of those with psoriatic arthritis. Despite its prevalence, it’s often misdiagnosed as a fungal infection or dismissed as an unrelated nail disorder. In this guide, we’ll explore how to identify nail psoriasis, effective treatment options, and the best ways to care for your nails.

What is Nail Psoriasis?

Nail psoriasis is a chronic autoimmune condition where the body’s immune system attacks healthy nail cells, causing abnormal nail growth, discoloration, and damage. It can occur on both fingernails and toenails, often appearing alongside skin psoriasis or psoriatic arthritis.

Nail psoriasis is not contagious, but it can severely impact a person’s self-esteem and quality of life. Many people with nail psoriasis avoid social situations, handshakes, or wearing open-toed shoes due to the appearance of their nails. This emotional and psychological impact makes proper treatment and care even more important.

How Common is Nail Psoriasis?

Studies suggest that up to 90% of people with severe psoriasis will experience nail involvement at some point. Even those with mild skin psoriasis can develop nail symptoms, often without noticeable plaques elsewhere on the body. Additionally, 80% of people with psoriatic arthritis will have some degree of nail psoriasis, making it a key indicator of the disease.

Symptoms of Nail Psoriasis

Nail psoriasis can manifest in a variety of ways, often making it difficult to diagnose. Here are the most common signs:

1. Nail Pitting

• Small dents or depressions in the nail surface

• Can appear as a few pits or cover the entire nail

• Caused by faulty keratin cell development

2. Discoloration

• Yellow, brown, or reddish spots (known as oil drop sign)

• White patches under the nail

• Bluish tint in some cases due to oxygen restriction

3. Thickened or Brittle Nails

• Nails may become thick, crumbly, or ridged

• Can be mistaken for a fungal infection (onychomycosis)

• Leads to discomfort and an increased risk of nail detachment

4. Nail Separation (Onycholysis)

• The nail lifts from the nail bed, creating a gap

• Often causes pain and increases infection risk

• Can make simple tasks, like typing or gripping objects, uncomfortable

5. Subungual Hyperkeratosis

• Excessive skin buildup under the nail, making it appear thick or raised

• Can cause discomfort and nail deformity

• Makes nail trimming difficult

6. Splinter Hemorrhages

• Small blood spots under the nail caused by capillary damage

• Resemble thin red or black streaks along the nail bed

What Causes Nail Psoriasis?

Nail psoriasis is an autoimmune disorder, meaning the immune system mistakenly targets healthy nail cells. The exact cause is unknown, but certain triggers can worsen symptoms, including:

• Genetics – Family history of psoriasis or psoriatic arthritis

• Stress – Can trigger flare-ups and worsen symptoms

• Injury to the Nails – Even minor trauma can lead to worsening psoriasis symptoms (Koebner phenomenon)

• Infections – Bacterial or fungal infections can make symptoms worse

• Smoking & Alcohol Consumption – Known to aggravate psoriasis

• Cold Weather – Dry, cold climates can exacerbate nail damage and inflammation

How is Nail Psoriasis Diagnosed?

Nail psoriasis is often misdiagnosed as fungal infections, eczema, or other nail disorders. A dermatologist will typically:

• Examine nail changes and symptoms

• Take a nail clipping to rule out fungal infections

• Assess any psoriasis history or joint pain to check for psoriatic arthritis

If you have both skin psoriasis and nail issues, chances are your nail symptoms are related to psoriasis rather than a fungal infection.

Treatment Options for Nail Psoriasis

There’s no one-size-fits-all approach to treating nail psoriasis, but a combination of topical, systemic, and natural treatments can help improve symptoms.

1. Topical Treatments

• Corticosteroid Creams or Ointments – Reduce inflammation and slow nail damage

• Vitamin D Analogs (Calcipotriol) – Helps normalize nail cell production

• Coal Tar and Salicylic Acid Preparations – Help reduce thickened nails and exfoliate buildup

• Nopsor Topical Treatment – A steroid-free alternative with coal tar, salicylic acid, and a proprietary herbal blend that soothes inflammation and promotes healing

2. Systemic Treatments (For Severe Cases)

• Biologics (Adalimumab, Secukinumab, Ustekinumab) – Target specific immune pathways to reduce inflammation

• Methotrexate or Cyclosporine – Used for widespread or severe nail psoriasis

• Retinoids (Acitretin) – Help regulate abnormal nail growth

3. Laser and Phototherapy

• Narrowband UVB Therapy – Helps reduce inflammation

• Excimer Laser Therapy – Targets affected nail cells with controlled UV light

4. Antifungal Treatments (If Fungal Infection is Present)

• Topical or Oral Antifungal Medications – Since nail psoriasis can mimic fungal infections, doctors may prescribe antifungals if an infection is present

Nail Care Tips for People with Nail Psoriasis

While medical treatments are essential, proper nail care can help reduce symptoms and prevent further damage.

1. Keep Nails Trimmed and Filed

• Short nails are less likely to lift or catch on objects

• Use a gentle glass nail file to smooth rough edges

2. Moisturize Regularly

• Use thick creams or petroleum jelly to keep nails and cuticles hydrated

3. Wear Protective Gloves

• Avoid prolonged exposure to water, chemicals, or cleaning products

• Cotton-lined rubber gloves can help protect nails

4. Avoid Nail Trauma

• Don’t bite or pick at nails, as this can worsen symptoms

• Avoid acrylic or gel nails, as they can increase damage

5. Skip Harsh Nail Polish Removers

• Use acetone-free nail polish removers to prevent drying out nails

6. Consider Supplements

• Biotin and Omega-3 fatty acids may help strengthen nails

Final Thoughts

Nail psoriasis is more than a cosmetic issue—it can impact daily life, confidence, and comfort. While it may take time to see improvements, consistent treatment and proper nail care can help manage symptoms and prevent further damage.

If you suspect you have nail psoriasis, work with your dermatologist to create a personalized treatment plan that works best for you.

References

• National Psoriasis Foundation – Comprehensive information on nail psoriasis, including symptoms and treatments.

  • https://www.psoriasis.org/locations-and-types​psoriasis.org

• Mayo Clinic – Overview of psoriasis, with specific details on nail involvement.

  • https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840​

• Mayo Clinic – Visual representation and explanation of nail psoriasis.

  • https://www.mayoclinic.org/diseases-conditions/psoriasis/multimedia/nail-psoriasis/img-20007734​mayoclinic.org+1mayoclinic.org+1

• Psoriasis.org – Insights into how nail symptoms can indicate psoriatic arthritis.

  • https://www.psoriasis.org/advance/what-your-nails-can-tell-your-doctor-about-psa