How Does Psoriatic Arthritis Affect the Nails?

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

People with psoriatic arthritis (PsA) live with pain and swelling in their joints, skin problems, and fatigue. But PsA can also affect the nails. This condition is called nail psoriasis.1

Nail problems affect about 80 percent of people who have PsA. They also can develop in people with psoriasis, an autoimmune skin condition linked with PsA. However, they are much more common in people with PsA.1,2

What does nail psoriasis do to your nails?

Nail psoriasis affects the underlying structure and function of the nail. It changes the actual nail (nail plate), the skin beneath the nail (nail bed), and the area where your nails start to grow (nail matrix).1-3

Nail psoriasis can occur on both the fingernails and toenails. You may have psoriasis on one or two nails, or you could have it on all of your fingernails and toenails at once.1

What does it look like?

Nail psoriasis can cause many physical symptoms, including:1-3

  • Small depressions on the nail plate (nail pitting) – This is the most common symptom.
  • Detachment of the nail from the nail bed (onycholysis)
  • White spots on the nail (psoriatic leukonychia)
  • Red spots in the crescent shape at the base of the nail
  • Horizontal grooves and ridges on the nail plate (Beau’s lines)
  • A thickened layer of the nail (hyperkeratosis)
  • Small lines of bleeding that run along the nail (splinter hemorrhages)
  • Crumbling of the nail – This happens after there has been nail pitting for a long time.
  • Nail discoloration – Nails may appear brown or yellow.
  • Fungal infections – Nail psoriasis puts nails at risk of getting infected.

In addition, nail psoriasis can cause pain that makes it hard to grasp small objects, tie shoelaces, or button clothes. Because nail psoriasis is located on the fingers and toes, it is visible to the world. This can impact a person’s quality of life and can cause anxiety, depression, embarrassment, and frustration.1,2

How is nail psoriasis treated?

Treatment options depend on how severe your nail psoriasis is. There are tests to assess the degree of psoriasis progression in the nails. One is called the Nail Psoriasis Severity Index (NAPSI). These tests can help your doctor find the most appropriate treatment regimen. Consult with your dermatologist or rheumatologist about which treatment might work best for you.2,3

For mild cases and when symptoms are only affecting the nails and not the skin, topical creams and ointments usually have good results. Your doctor may suggest a strong topical steroid, which has been shown to help with mild nail psoriasis. Light therapy may also be helpful when only a few nails are affected.2

For people with more severe cases, drugs that block inflammation can be helpful. These include:1-3

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologic drugs

Tips for managing your nail psoriasis

Nail psoriasis can be tricky to handle. But it is possible to manage the condition. Here are some tips and tricks to try:1,3

  • Keep nails trimmed short.
  • Keep nails clean and dry to reduce the risk of infection.
  • Do not pick at your cuticles or nails.
  • Do not use nail polish, nail polish remover, or any harsh chemicals on your nails.
  • Wear gloves when doing the dishes, yard work, and household chores to protect your nails.
  • Avoid tight shoes that could pinch your toes.
  • Wear clean, dry socks, and keep feet and toes clean.
  • Avoid activities that could cause minor trauma to the fingers and toes.

The sooner you treat nail psoriasis, the better. Work closely with your dermatologist or rheumatologist to manage and keep nail psoriasis symptoms under control.3

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