Buzz
Although commonly regarded as a skin ailment, psoriasis can extend to the nails, resulting in fissures, discoloration, and roughness. Managing nail psoriasis can prove challenging, often requiring up to a year for nail restoration. Thankfully, a variety of treatments exist to bolster and rejuvenate your nails. Given their heightened fragility, diligent nail care during treatment is imperative.
Procedures
Treating Psoriatic Nails
Consult a primary care physician or dermatologist: These professionals can prescribe specialized medications and administer injections to address nail psoriasis. Additionally, they can assess if fungal infections are contributing to nail conditions.
- Your physician will evaluate your nail health, observing for psoriasis indicators like pitting, thickening, nail bed separations, and discoloration.
- Fingernail clippings may be sent for fungal infection testing, as fungal presence can exacerbate psoriasis symptoms.
Apply corticosteroid ointment nightly: Your physician may prescribe a potent steroid or suggest a milder over-the-counter variant. Before bed, cover the entire nail with the steroid. Massage it onto the nail bed beneath the cuticle. Wrap your nails in plastic wrap to prevent the ointment from rubbing off while you sleep.
- Do not exceed 2 weeks of corticosteroid use unless advised by your physician.
Use other topical medications: Apart from corticosteroids, your doctor might recommend additional medicated creams, ointments, or gels. Apply these once or twice daily to the affected areas of your nail as per your doctor's instructions. Some topical treatments may include:
- Vitamin D3 derivatives
- Retinoids
- Anthralin
- 5-Fluorouracil
Opt for injections: Injections are administered every 4-6 weeks. Your doctor will apply a local anesthetic to the nail area before injecting the medication beneath your nail.
- Common medications administered include Triamcinolone or Biologics like Infliximab.
- Always ensure a healthcare professional administers your medication.
Consider phototherapy: PUVA therapy involves exposing your nails to ultraviolet light. Before the procedure, your hands or feet are soaked in a solution called Methoxsalen. You then expose them to UVA rays using a PUVA device.
- Alternatively, your doctor might provide pills or lotions, although less common for nail psoriasis.
- In some instances, you may stand in a full-body booth for UVA exposure, wearing goggles provided by your doctor.
Remove severely affected nails: If psoriasis extensively damages your nail, your doctor may opt to remove the entire nail to facilitate regrowth. This is achieved by applying a urea solution to soften the nail, which is then removed.
- The urea treatment typically takes up to a week to dissolve the nail fully, but it's painless, and the nail may naturally detach.
- Regrowth of the nail may take 3-6 months post-treatment.
Consider systemic therapy for severe nail psoriasis: Systemic treatments target your entire body, not just your nails. These can be pills or injections. If your psoriasis extends beyond your nails or if your nail psoriasis is severe, your doctor may suggest one of these treatments.
- Examples of systemic treatments may include methotrexate, retinoids, and cyclosporine.
Treat fungal infections with antifungal ointments or pills: Psoriasis-affected nails are more prone to fungal infections. If you have a fungal infection, your doctor will prescribe an antifungal medication appropriate for the specific fungus type. Follow the medication instructions carefully.
- Treating the fungus won't cure nail psoriasis but prevents worsening of the nail condition.
Nail Care Tips
Soak nails in warm, soapy water for cleaning: Avoid using picks or cotton swabs to clean under your nails, as it may lift the nail from the bed. Soak nails in warm, soapy water for 5-10 minutes to remove dirt without causing damage.
- Gently pat nails dry with a towel afterward.
- Prefer hand washing over alcohol-based sanitizers to prevent dryness. Follow up with moisturizer.
Keep nails clipped short: Longer nails are more prone to breakage or injury. Trim nails to finger or toe length using clippers or scissors. Aim to clip nails every 1-2 weeks based on their growth rate.
Trim hangnails as soon as you notice them: Use nail clippers or scissors to remove hangnails. Cut them as close to the skin or nail as possible. Avoid biting or pulling them off.
Gently buff the nail surface with a file: Use an emery board, foam nail buffer, or nail file. Glide it smoothly over the nail surface to buff them. File the nail edges to make them smooth, applying gentle pressure.
Moisturize your hands and nails daily: Prevent nail dryness by applying moisturizer. Opt for hand or nail moisturizers containing oils, and massage them into the nail bed near the cuticles.
Avoid cutting or pushing back cuticles: Cuticles protect the nail bed, often most affected by psoriasis. Refrain from disturbing them, and inform manicurists not to cut or push them back during a manicure.
Use nail polish to enhance nail appearance: Nail polish can conceal discoloration or roughness. Opt for clear polish for a smoother appearance or colored polish to hide discoloration. Avoid fake or acrylic nails, which can exacerbate natural nail psoriasis.
- If nail polish causes dryness or cracking, take a break. Use a non-acetone nail polish remover for gentler removal.
Preventing Further Damage
Keep your nails dry whenever possible: After washing your hands or showering, ensure thorough drying, especially around the nails, to minimize the risk of fungal infection.
Protect your nails with gloves during manual tasks: While your nails heal, shield them from damage with rubber or fabric gloves during activities such as dishwashing, gardening, heavy lifting, or chemical cleaning.
Opt for larger shoes if toenails are affected: Alleviate discomfort by wearing shoes half a size or a full size larger. This prevents toenails from rubbing against shoes, which can exacerbate psoriasis. Consult a podiatrist if needed for specialized footwear.
Break the nail-biting habit: Nail biting can worsen nail psoriasis. Combat the urge by chewing gum or squeezing a stress ball instead. Quitting nail biting promotes healthier nails and improves psoriasis appearance.
Consider an autoimmune-friendly diet: Strengthen your immune system and promote healthier nails by adopting a diet low in gluten and dairy, while rich in vitamin D. These dietary choices can alleviate symptoms of psoriasis and enhance nail health.
Tips
Warnings
- Nail psoriasis is notoriously challenging to treat. Be patient and try various treatments until you find what works best for you.
- It may take a year or longer for nail psoriasis to fully resolve.
