Psoriasis: Nails

Key Points
Form of psoriasis affecting the nails
Exact cause is unknown, but seems to be caused by functional errors in the immune system
*Presentation of symptoms predicated on the part of the nail affected

Psoriasis of the nails is a form of psoriasis which affects the finger and/or toenails. The condition may affect the nail bed, nail matrix, midmatrix and hyponychium, and presents differing symptoms depending on which area is affected. In addition, the condition may carry an increased risk of secondary infection due to the deformity of the nail unit.

The exact cause of all types of psoriasis, including psoriasis of the nails, is unknown, though it is thought to be caused by functional errors in the immune system. The condition affects men and women equally, though often women will show signs at an earlier age. Psoriasis of the nails usually occurs in conjunction with psoriasis in other areas, and is more commonly seen in conjunction with psoriatic arthritis.

Differential Diagnosis (Other conditions with similar appearance)
Alopecia Areata
Lichen Planus
Onychomycosis
Pityriasis Rubra Pilaris

Diagnosis
Key Points
Diagnosis typically based on appearance of the affected area
Nail biopsy may be performed to rule out other conditions

Psoriasis of the nails is typically diagnosed based on the appearance of the affected area. A nail biopsy may be performed to rule out similar appearing conditions.

<p data-preserve-html-node="true" Treatment
While there is no cure, some cases may resolve spontaneously
The condition is benign
*Various therapies may be recommended, with varying degrees of effectiveness

While there is no cure for psoriasis of the nails, the condition may resolve itself spontaneously in some cases. Though the condition is benign, most affected persons desire treatment as it is uncomfortable and may cause functional issues. There are various therapies which may be recommended, though their effectiveness varies. These therapies include topical remedies such as calcipotriol and potent corticosteroids. Health care professionals may also recommend systemic therapies such as methotrexate, biologics, retinoids and ciclosporin, or other treatments such as localized intralesional triamcinolone acetonide Injections or psoralen/UVA therapies. Antifungals may be prescribed if secondary infection develops.