Authors: Vanessa Ngan, Staff Writer, 2003; A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, February 2016; DermNet NZ Update August 2021. Copy edited by Gus Mitchell
Nail psoriasis, also known as psoriatic nail dystrophy, is due to psoriasis involving the nail matrix or nail bed, resulting in specific and non-specific clinical changes in the nail.
Nail psoriasis affects 90% of patients with chronic plaque psoriasis at some time in their life. It is more common in adults with a prevalence of up to 80%, compared to children in whom it has been reported in 7–13%. In the absence of skin or joint disease, psoriatic nail disease has been described in 5–10% of adults.
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Psoriatic nail disease may be a risk factor the development of psoriatic arthritis and is often associated with prolonged severe cutaneous psoriasis.
Nail psoriasis can affect all races and age groups, and both sexes, although a male predominance has been reported in one large case series.
Psoriatic nail dystrophy can cause tenderness and pain, altered sense of fine touch, and difficulty picking up or manipulating objects such as shoelaces or buttons.
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The severity of nail psoriasis can be estimated using the Nail Psoriasis Severity Index (NAPSI) in which each nail is divided into quadrants and scored for clinical signs to come up with a numerical score.
Nail clippings for fungal microscopy and culture should be taken as onychomycosis may precede or complicate psoriatic nail dystrophy, and immunosuppressive medications may be used in treatment.
A proximal nail matrix biopsy is occasionally needed to confirm the diagnosis of nail psoriasis, particularly in the absence of signs of psoriasis elsewhere or where only a single nail is affected and a tumour cannot be excluded by other means. Biopsy can lead to permanent nail deformity.
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Nail psoriasis has a variable response to treatment. The visible response may take weeks or months due to slow growth of the nail plate, and relapses are common.
DermNet does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice.Psoriasis is a chronic condition that affects the largest organ of the body – the skin. As a result, skin cells accumulate to form scaly skin that is itchy and dry. This condition cannot be entirely cured. However, adequate and timely treatment can alleviate the symptoms. Half of the population experiencing psoriasis of the body end up contracting nail psoriasis as well.
Nails are actually a part of the skin. Nails grow from the matrix that is the nail root which is situated right under the cuticle. Psoriasis affects the skin and leads to nail psoriasis by bringing about a change in the physical appearance of the nails. It can also cause mild pain or make the nails feel tender or sore. About 10-20% of those who have cutaneous psoriasis (skin) simultaneously develop arthritis too, a condition known as psoriatic arthritis. Eighty percent of people with psoriatic arthritis end up with psoriasis of the nails too.
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Most victims of nail psoriasis are embarrassed by this condition and shy away from any work that makes their hands exposed. Their nails lack strength and shine. Psoriasis of the nails can affect people of any age, race or gender. It is still unclear as to why some people have affected nails and why others do not.
The “root” cause of nail psoriasis is in the nail root which is the skin tissue of the nail bed from where the nail grows. Changes in the growth pattern of the cells in the nail root results in the development of the disease.
Another cause for nail psoriasis is fungal infections like onychomycosis that cause thickening of the nails. This nail fungus produces the symptoms shown in psoriasis.
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Nail psoriasis symptoms affect both toenails as well as finger nails. They can affect either one nail or all of them depending on the severity of the nail disease. The following clinical complaints are observed by nail psoriasis patients:
Nail health is deeply impacted by nail psoriasis. It is often embarrassing and unsightly to suffer from this condition. It is coupled with either one or more of the following complications:
The diagnosis is made much faster in individuals who suffer from plaque psoriasis (the most common form of the disease characterized by bumpy, red patches).
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There is no complete cure for nail psoriasis; one can only use a prolonged treatment regimen in order to keep this fingernail disorder under control. Psoriasis treatment includes the following:
Regardless of the type of treatment option, it is important to stay patient. These treatment plans work on the new nail and the process of outgrowing the defected nail takes at least a year for fingernails and twice as much for toe nails.
Psoriasis of the nails affect the dexterity and overall functioning of one’s hands. It is always better to take simple steps to prevent this nail disorder than battle it later.
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