Treatment Options for Nail Psoriasis

Reviewed by: HU Medical Review Board | Last reviewed: June 2022 | Last updated: April 2023

With psoriatic arthritis (PsA), there is a risk of developing nail psoriasis. In fact, 80 to 90 percent of people with plaque psoriasis will develop nail bed or nail matrix (the area where nails start to grow) symptoms. The number is even higher in people with PsA.1

Hitting the nail on the head...

These symptoms are often hard to predict and can vary greatly from person to person. People may also respond very differently to identical treatments. This has made it hard for doctors to determine which treatments are most effective and develop a standard of care.

Is my nail psoriasis severe?

Systemic treatments work to treat the entire body. These treatments have more side effects, and some may be severe.

Side effects include kidney problems, high blood pressure, gastrointestinal disorders, fatigue, and tingling or prickling sensations in the hands and feet.1

What are the most common treatments?

The common therapies for nail psoriasis often include the following methods:1

  • Topical drugs applied on the nails
  • Intralesional drugs injected into the nails
  • Conventional systemic drugs that treat the body as a whole
  • Biologic systemic drugs that treat the body's immune system
  • Non-drug options

Nail growth is slow, as is the response to treatments. These methods may not reduce symptoms for 12 weeks up to 1 year after starting them. It is important to talk to your doctor about which treatment methods may be right for you.1

Understanding topical treatments

Topical treatments are usually recommended for nail psoriasis that is fairly mild and without signs of severe PsA or plaque psoriasis symptoms. The most effective way to use topical treatments is to determine where the nail psoriasis is located.

This is because some treatments work better for nail bed psoriasis, while others are better for nail matrix psoriasis. Topical drugs are generally applied 1 to 2 times a day and have relatively mild side effects.1

Topical treatments vary and may include:1

  • Steroids
  • Steroids combined with other substances, such as vitamin D3
  • Topical calcineurin inhibitors (drugs that affect the immune system)

Steroids can also be injected intralesionally if the nail psoriasis is more severe.

Are systemtic treatments available?

Systemic drugs often show a moderate improvement in nail psoriasis. However, they are generally used only for severe cases of nail psoriasis or in people who have severe PsA or plaque psoriasis along with nail symptoms.

Systemic treatments include methotrexate, cyclosporine, soriatane, and retinoids. In most cases, systemic drugs cannot be used for prolonged periods of time.1

Can I use biologic treatments?

Biologic treatments are very similar to systemic treatments, both in usage and side effects. However, biologic treatments are newer. This means they are often more expensive and less researched.1

Many biologics target the body's immune response. Drugs include:1

  • Anti-tumor necrosis factor alpha blockers – infliximab, adalimumab, etanercept, and golimumab
  • Interleukin (IL)-17 inhibitors – secukinumab, ixekizumab
  • IL-12/23 inhibitors – ustekinumab

What else can I try?

Non-drug treatments are the least researched of all treatments and have shown the least amount of promise for nail psoriasis. Because of this, they are not recommended as a first-line treatment for nail psoriasis. In most cases, they are only recommended when other treatment options have failed.1

Treatments in this category include laser treatment, phototherapy, and radiotherapy.

Before beginning treatment for nail psoriasis, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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