Nail psoriasis, identify the symptoms, causes and how to treat it

Psoriasis is a chronic disease that causes dry, reddish skin covered with thick, scaly, silvery white patches that feel itchy and painful. Psoriasis symptoms often appear on the scalp, elbows, knees, and can also spread to the toenails and hands.

Psoriasis that affects the nails can make them look dull and hollow. So, will everyone who has psoriasis experience the same symptoms on their nails?

What causes psoriasis on the nails?

In some people who have psoriasis, the symptoms can also appear on the nails. A study from Radboud University Medical Center conducted in 2016 noted that 80 - 90 percent of people with psoriasis vulgaris experience it on their nails.

Psoriasis is a chronic skin disease caused by a disturbance in the response of the immune system. Instead of fighting bad microorganisms, the immune system attacks healthy skin cells.

This condition is called an autoimmune disorder and causes skin regeneration to take place faster than it should be, resulting in a buildup of the skin layers.

The mechanism of attack by the immune system against healthy skin cells is not certain. Some of the things that are known to cause psoriasis of the nails are:

• a family history of psoriasis,
• hormonal changes,
• stress,
• sores on the skin,
• bacterial and viral infections,
• use of certain drugs,
• excess alcohol consumption, as well
• smoking habit.

What are the signs and symptoms of psoriasis on the nails?

The appearance of psoriasis on the nails is identical to that of nails damaged by a fungal infection. However, there are some differences in symptoms between nail fungal infection and nail psoriasis. Here's a list of the symptoms.

1. Change in color

Psoriasis will cause your nails to turn yellow, brown, or even slightly greenish in color. In addition, there are also small red or white spots around your nails.

2. Pitting on the nails (grooved / perforated nails)

The nail plate is the hard surface that forms the top of your nail. These plates are composed of keratin cells.

Psoriatic inflammation causes your nail plates to lose keratin cells. Well, this causes the appearance of small holes in the shape of your fingernails or toenails.

The number and size of these holes can vary from person to person. Some people may only have one hole in each nail, while others have more. Holes can penetrate all and part of the nail surface.

3. Changes in the shape and thickness of the nails

You may also notice changes in the shape and texture of your nails. Psoriasis can cause your nails to become brittle and break easily so they are no longer intact.

Conditions like this are prone to causing infection. Over time the nails can thicken due to a fungal infection called onychomycosis. In addition, psoriasis can also cause the appearance of Beau's lines, which are in-line indentations on the surface of the nails.

4. Loose nails

Sometimes psoriasis can cause your nail plate to fall off from the nail bed. This separation of the nail from the nail bed is called oncolysis. As a result, this leaves empty spaces or gaps under your nails, allowing infection to develop.

This symptom may also be accompanied by a yellowish or whitish patch that spreads to the cuticle, the layer of skin at the base of the nail.

5. Subungual hyperkeratosis

This condition is characterized by the appearance of white, chalk-like lumps that can spread under the nails, forming holes or gaps. This causes your nails to feel uncomfortable or painful when you apply pressure to them.

If Subungual hyperkeratosis occurs in toenails, you may feel pain when wearing shoes. In addition, you will have difficulty moving your fingers, fingernails and toenails, which will hinder your daily activities.

How to treat psoriasis on the nails?

Psoriasis cannot be completely eliminated from the body, but proper and routine psoriasis treatment can control symptoms for a long time.

You certainly have to consult a doctor first so you can get the right treatment according to the psoriasis condition you are experiencing. The reason is, the severity of this disease for each person can be different.

However, usually treatment for nail psoriasis includes the following.

• Topical steroid medication: a strong corticosteroid cream will help reduce various symptoms of psoriasis on the nails. Usually the drug is applied to the affected nail once or twice a day and continued for several months.
• Calcipotriol (calcipotriol): a derivative of vitamin D that is often used to treat psoriasis symptoms. This cream is believed to be as effective as corticosteroids and is known to be effective in treating the buildup of tissue under the nails.
• Tazaerotene: topical medication that works to treat symptoms such as holes in the nails and can treat nail discoloration.

If it turns out that your condition requires stronger treatment, your doctor may perform several treatment procedures in the hospital. Some that are often done are:

• Corticosteroid injections: corticosteroids will be injected directly into or near the nail area that has psoriasis. If the results from the first injection do not improve your condition, you may need to get another injection a few months later.
• Laser: several such treatments pulse dye laser can give effective results in some patients. Pulse dye laser destroys small blood vessels in the area around psoriasis, stops blood flow, and reduces cell growth in that area.
• PUVA: a nail psoriasis treatment procedure using artificial UVA exposure that is preceded by taking the drug psoralen. PUVA can treat symptoms of discoloration of the nails, but is not quite successful in treating nail pitting.

If psoriasis can cause severe disabilities, such as being unable to walk, then your doctor may prescribe systemic medications. This drug affects a person's entire body, not just problem areas. Examples of systemic drugs include methotrexate and ciclosporin.

Remember, treatment should be done in the early days when new psoriasis appears. Nail growth also tends to be slow, which is why the results of the new drugs will show after a few months of using them.

How to prevent psoriasis on the nails?

Good nail care is the best way to prevent it. Follow some of the steps below to take care of your nails painstakingly.

• Cut nails regularly, but make sure they are not too short when cutting them.
• Wear gloves for cleaning and doing other work that comes into contact with your hands.
• Moisturize your nails and cuticles every day, especially after you come into contact with water.
• Wear shoes that are comfortable and not too small so that you have enough room for your toes.
• Avoid cleaning nails with a nail brush or sharp objects. This is done to prevent your nails from falling off.