Nail Psoriasis

Overview

What is nail psoriasis?

Nail psoriasis is an autoimmune disease that causes your skin cells to reproduce quickly. It’s a type of psoriasis that affects the nails on your fingers and toes.

Nail psoriasis typically appears along with a psoriatic rash on other parts of your body.

Who does nail psoriasis affect?

Anyone can get nail psoriasis. However, you may be more likely to develop nail psoriasis if you:

  • Are over 40 years old.
  • Are assigned male at birth.
  • Have psoriasis or a family history of psoriasis.
  • Have psoriatic arthritis.

How common is nail psoriasis?

Nail psoriasis is common. It affects over 50% of all people with psoriasis and around 86% of all people with psoriatic arthritis.

Symptoms and Causes

Is nail psoriasis a fungus?

No, nail psoriasis isn’t a fungus. Nail psoriasis is an autoimmune disease. Your immune system overreacts, which leads to new skin cells growing too fast.

What are the symptoms of nail psoriasis?

Symptoms of nail psoriasis include:

  • Discoloration: The skin underneath your nails (nail bed) may change colors. These changes, called salmon patches or oil drop spots, may look yellow, red, pink or brown.
  • Pitting: Your nails may develop dents or pits (cupuliform depressions). They can be as small as the tip of a pin (0.4 millimeters) or as large as the tip of a crayon (2 millimeters), and they can be shallow or deep. You may only have one or two pits on your nails, or you may have more than 10 per nail.
  • Changes in nail structure: You may develop grooves that run horizontally across your nails (Beau’s lines). Your nails may grow so thin that they start to crumble. The thick layer of skin underneath the tip of your nail may also start to peel and slowly separate from the nail bed (onycholysis), which may lead to the development of nail fungus.

Some of these symptoms may result in discomfort, tenderness or pain that can affect your comfort or ability to stand, walk or use your hands.

What causes nail psoriasis?

Nail psoriasis is an immune system problem. Typically, new skin cells grow every 28 to 30 days. However, in people with psoriasis, new cells grow and move to the skin surface every three to four days, which creates a skin rash. In some people with psoriasis, it affects their nails in addition to their skin or other parts of their bodies.

Is nail psoriasis contagious?

Nail psoriasis isn’t contagious. You can’t spread nail psoriasis to another person through skin-to-skin contact.

Diagnosis and Tests

How is nail psoriasis diagnosed?

Your healthcare provider can typically diagnose nail psoriasis after a physical exam. They’ll examine your affected areas to look for common signs of nail psoriasis. They’ll also ask about your symptoms and your family history.

Once your healthcare provider has diagnosed nail psoriasis, they may use the nail psoriasis severity index (NAPSI) to grade its severity. The NAPSI uses imaginary lines to divide your nail into four even sections (quadrants). Your nails receive a 0-4 score based on the presence of any nail psoriasis symptoms in each of the quadrants. Your healthcare provider will then add the scores together. A low number means your nail psoriasis is mild, and a high number means your nail psoriasis is more severe.

Infographic explaining how the NAPSI index is used to diagnose the severity of nail psoriasis.
People with nail psoriasis may develop a number of symptoms. Providers use NAPSI to determine the severity of the condition.

If there’s any doubt about your symptoms, your healthcare provider may order a potassium hydroxide (KOH) preparation or fungal culture to rule out a fungus as the cause of your symptoms. If those test results aren’t clear, a fungus test known as a periodic acid-Schiff (PAS) stain can also determine the presence of a fungus.

Management and Treatment

Can nail psoriasis go away on its own?

There isn’t a cure for nail psoriasis. It’s a long-lasting (chronic) condition, which means flare-ups can occur throughout your life. You may have flare-ups and times when the symptoms go away (remission). Treatments can provide relief for your symptoms.

How do you treat nail psoriasis?

Nail psoriasis is often resistant to some treatment options, so it can be challenging to manage without standard treatment. You and your healthcare provider may have to explore different treatment options, including:

  • Corticosteroids: Your healthcare provider may prescribe a corticosteroid cream, ointment or nail polish. For corticosteroids to effectively treat your nail psoriasis, they must reach the nail bed and the area of your fingers where the nail starts to grow (nail matrix), which can be difficult. You may have to apply the medication up to twice a day, and you may not see noticeable improvement until at least four to six months.
  • Medicine injections: In more serious cases of nail psoriasis, your healthcare provider may use a thin needle to inject medicine into the skin around your nails. These medicines may include etanercept, adalimumab or ustekinumab.
  • Oral medicines: In more serious cases of nail psoriasis, your healthcare provider may prescribe liquid medicines or pills or tablets that you swallow with water. These medicines may include methotrexate, cyclosporine or apremilast.
  • Phototherapy: Phototherapy uses ultraviolet light from special lamps. Your healthcare provider may use a drug called psoralen combined with ultraviolet A (PUVA) or ultraviolet B (UVB). The ultraviolet light waves in phototherapy can help certain skin and nail disorders, including nail psoriasis.
  • Laser therapy: Your healthcare provider may use a pulsed dye laser (PDL) to target the blood vessels under your nails, which may reduce the severity of nail psoriasis. Laser therapy treatments usually occur every six months.

Are there any home remedies or tips for symptoms of nail psoriasis?

There are several home remedies and tips that can help control the symptoms of nail psoriasis.

While home remedies are safe for most people, it’s a good idea to check with your healthcare provider before trying some of the following options. You may be at risk of developing an allergic reaction.

  • Aloe vera: Aloe vera gel has anti-inflammatory properties that may relieve the symptoms of nail psoriasis. Apply aloe vera gel to your nails and the surrounding skin up to several times a day, including before bed.
  • Capsaicin: Capsaicin is a chemical compound naturally found in hot peppers that gives peppers their spicy taste. Capsaicin creams or ointments may relieve the symptoms of nail psoriasis. However, be careful not to touch or rub your eyes after applying it, because it can cause eye irritation.
  • Dead Sea salt: Dead Sea salt comes from the Dead Sea in southwest Asia, and it can provide relief from nail psoriasis symptoms. Add Dead Sea salt to a bowl of warm water — around 95 degrees Fahrenheit (35 degrees Celsius) — and soak your nails for at least 10 minutes. You may have to soak your nails several times per week.
  • Turmeric: Turmeric is a spice that contains a chemical called curcumin. Studies show that curcumin has anti-inflammatory and anti-fungal properties that may relieve the symptoms of nail psoriasis. You may add turmeric as a spice to foods in your diet, or you may take it as a tablet or pill in specific dosages.

It’s also a good idea to:

  • Wash your hands and nails regularly to prevent an infection.
  • Moisturize your nails and the skin around your nails.
  • Keep your nails trimmed short.
  • Apply a nail hardener polish.
  • Cut off hangnails.
  • Wear gloves when doing activities that may damage or dry out your nails or the skin around your nails, like washing the dishes, playing sports or working outside.

If your nail psoriasis makes you feel self-conscious or embarrassed, you may gently buff your nails and apply nail polish to hide any pits or discoloration and improve your nails’ appearance. However, avoid using fake nails. Fake nails can damage your actual nails.

Prevention

How can I reduce my risk of developing nail psoriasis?

There isn’t any way to prevent nail psoriasis. If you have nail psoriasis, it may come and go throughout your life. Treatments can reduce symptoms, even in people with severe nail psoriasis.

Outlook / Prognosis

What can I expect if I have nail psoriasis?

Nail psoriasis may flare up and go into remission throughout your life. However, it can generally be well managed with treatment.

Are there any other complications of nail psoriasis?

If you have nail psoriasis, you may be at a higher risk of:

Living With

How do I take care of myself?

If you have nail psoriasis, the best way to take care of yourself is to:

  • Take medications or apply treatments as instructed.
  • Regularly clean, trim and moisturize your nails, and protect your nails from harm.

When should I see my healthcare provider?

Contact your healthcare provider if:

  • You develop new symptoms.
  • Your symptoms don’t improve after treatment.
  • The skin around your nails looks infected (red, purple, gray or white skin; irritation and swelling).

What questions should I ask my healthcare provider?

  • How can you tell that I have nail psoriasis?
  • If I don’t have nail psoriasis, what other condition might I have?
  • How can I prevent flare-ups and control my symptoms?
  • What medicines do you recommend?
  • Do the medicines have any side effects?
  • What at-home treatments do you recommend?
  • Do the at-home treatments have any side effects?
  • What else should I do to improve my symptoms?
  • Is there a cream or ointment that you can prescribe?
  • Should I see a dermatologist or another specialist?

A note from Cleveland Clinic

Nail psoriasis is an autoimmune disease that causes discoloration, pitting and changes in the structure of your nails. It can make you feel self-conscious, though you can buff your nails and apply nail polish to improve their appearance. Nail psoriasis isn’t contagious, and treatments can help your symptoms improve.

It’s important to pay attention to your nails. Contact your healthcare provider as soon as you notice changes to your nails.

Last reviewed by a Cleveland Clinic medical professional on 04/25/2022.

References

  • Haneke E. Nail Disorders. In: Kang S, Amagai M, Bruckner AL, et al., eds. Fitzpatrick's Dermatology, 9e. McGraw Hill; 2019. Accessed 4/25/2022.
  • Jefferson J, Rich P. Nail Disorders. In: Kelly A, Taylor SC, Lim HW, et al., eds. Taylor and Kelly's Dermatology for Skin of Color, 2nd Edition. McGraw Hill; 2016. Accessed 4/25/2022.
  • Mayeaux, Jr. EJ. Psoriatic Nails. In: Usatine RP, Smith MA, Mayeaux, Jr. EJ, et al., eds. The Color Atlas and Synopsis of Family Medicine, 3rd Edition. McGraw Hill; 2019. Accessed 4/25/2022.
  • Nardo VD, Gianfaldoni S, Tchernev G, et al. Use of Curcumin in Psoriasis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816303/) Open Access Maced J Med Sci. 2018; 6(1): 218-220. Accessed 4/25/2022.
  • Schons KR, Knob CF, Murussi N, et al. Nail Psoriasis: A Review of the Literature. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008063/) An Bras Dermatol. 2014; 89(2): 312-317. Accessed 4/25/2022.

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