If you have psoriasis and you notice some changes in your nails, there are many treatments you can turn to for help.
Nail psoriasis alters the way your toenails and fingernails look. They may get thick, develop pinprick holes, and change color or shape. They also can feel tender and hurt.
You can treat these problems with medicine. Cosmetic repairs can make your nails look better.
Symptoms of Nail Psoriasis
You’ll know you’re getting nail psoriasis when you see these changes in your fingernails or toenails:
- Color. Your nails may turn white, yellow, or brown. They may also have small red or white spots underneath.
- Surface appearance. You may get ridges or grooves in your nails or pitting (small pinprick holes) on the nail surface.
- Debris buildup. Chalky white material can gather under your nail, causing it to lift away from the skin. This can be painful.
- Thickening. About a third of people with nail psoriasis can also get a fungal infection that can cause your nails to get thick. They may also get brittle and break.
- Separation. Your nail may loosen or separate from the nail bed.
Some of these nail changes can make it hard to move your fingers and toes. You may also get tenderness and pain in your nails. This can make it hard to do things with your hands.
Prevention of Nail Psoriasis
Good nail care is the best way to treat nail psoriasis. Try these prevention tips:
- Keep your nails trimmed short.
- Use a nail file to keep nail edges smooth.
- Wear gloves to clean and do other work with your hands.
- Moisturize your nails and cuticles every day and after they’ve been in contact with water.
- Wear comfortable shoes with enough room for your toes.
If you’re unhappy with the way your nails look, try nail varnish or artificial nails. They can also protect your nails from more damage. Some people are sensitive to the chemicals in varnish and nail adhesive. Talk to your doctor about whether these are right for you.
Treatments for Nail Psoriasis
The same treatments you get for skin psoriasis can also treat your nail psoriasis. Because your nails grow slowly, it can take time before you see any improvements in the newly grown parts of your nail.
The treatments for nail psoriasis include:
Phototherapy. Ultraviolet light is used to treat skin psoriasis and may also be useful in nail psoriasis. The treatments usually take place in a doctor’s office or a clinic.
Medicines that work throughout your body. Your doctor may call these “systemic medications.” Some examples are:
- Acitretin (Soriatane)
- Apremilast (Otezla)
- Cyclosporine (Sandimmune)
- Methotrexate
Drugs that target specific parts of your immune system. You may hear your doctor call these “biologics.” They are given by injection under the skin, in a pill, or through an IV. Some examples are:
- TNF-alpha inhibitors:
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Etanercept-szzs (Erelzi)
- Infliximab (Remicade)
- Interleukin 17 inhibitors:
- Brodalumab (Siliq)
- Ixekizumab (Taltz)
- Secukinumab (Cosentyx)
- Interleukin 23 inhibitors:
- Risankinumab (Skyrizi)
- Guselkumab (Tremfya)
- TIldrakizumab (Ilumya)
- Interleukin 12 and 23 inhibitor:
- Ustekinumab (Stelara)
Medicine you apply directly to your nails. Your doctor may call these “topical” drugs. For nail psoriasis, they may suggest a corticosteroid (such as clobetasol), vitamin D, or retinoid creams that you rub into your nail and cuticle every day.
If your nails are thick, the medicine you apply may have a hard time getting inside. Gels or ointments that contain urea can help thin them.
Your doctor may also prescribe a nail lacquer that hydrates and strengthens your nails. You apply it every day in the same way you put on nail polish.
Corticosteroid injections. These are put under your nail surface every 2-9 months. Your doctor will numb the area or use a nerve block to reduce pain.