The Heartbreak of Psoriasis

Some 50% of all people who have psoriasis have nail changes. That figure climbs to 80% for those with psoriatic arthritis. Most often these changes express themselves in pitting, changes in the overall shape of the nail, thickening, a separation of the nail from the nail bed, and discoloration.

Brief Respite

Psoriasis attacks the nail as it is formed making it quite a challenge to treat. The formation of nails starts in the matrix, which is tough to penetrate with topical medicines. Sometimes steroid injections at the site of the nail bed or matrix is helpful, but the injections are painful and don't always work. Even when the injections give relief, this tends to be only a brief respite from the pain of psoriatic nails.

Other than topical treatments and steroid injections, there is phototherapy and cosmetic nail repair. Phototherapy can be given either as a topical or oral treatment which increases the nail's sensitivity to UV rays. Cosmetic repair for nails that have become misshapen by psoriasis involves removing the nail either surgically or with a powerful urea compound. Sometimes the nails can be filed down, buffed, and polished or artificial nails can be applied.

In the case where a psoriasis patient is taking medication along the lines of methotrexate, or PUVA as phototherapy, the nails tend to respond to treatment as well, so that no additional medications are needed. Nail improvement is slower than the healing of the skin lesions, so be forewarned. On the other hand, some of the oral retinoids, like Soriatane, may work wonders for your skin lesions, but may cause your nails to thin and appear abnormal. It may take several months for your nails to go back to their normal appearance after you discontinue this treatment. 

Keep Nails Short

In terms of home nail care, it's best to trim the nails back to the point where there is a firm attachment, using a manicure scissors. Keep your nails as short as possible. Loose nails increase the chance of trauma which in turn may trigger a bout with psoriatic nails or worsen an existing condition. Wearing gloves gives added protection while you are working with your hands.

Tar soaks can be helpful. Dissolve three capfuls of tar bath oil, available at pharmacies, into a bowl of warm water. Leave your fingers to soak in this solution for 20 minutes. After a soak, rub some moisturizer into each nail.

If your nails aren't in terrible shape, a nail hardener or artificial nails can make a big difference in their appearance. Keep in mind that many psoriatic nail patients are sensitive to the ingredients in these items which may worsen the problem.

Toenails are soaked for 10 minutes in warm water. Using a gentle touch, file the thickened areas of the toenails with an emery board. Then use good quality nail clippers to cut off a small sections of nail, a bit at a time. Try to cut straight across the nail to prevent the formation of ingrown toenails. Psoriatic nail patients are advised to wear roomy shoes to prevent the toes from rubbing against the shoe, which might cause a thickening of the nails.