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This article was medically reviewed by Sarah Gehrke, RN, MS. Sarah Gehrke is a Registered Nurse and Licensed Massage Therapist in Texas. Sarah has over 10 years of experience teaching and practicing phlebotomy and intravenous (IV) therapy using physical, psychological, and emotional support. She received her Massage Therapist License from the Amarillo Massage Therapy Institute in 2008 and a M.S. in Nursing from the University of Phoenix in 2013.
There are 16 references cited in this article, which can be found at the bottom of the page.
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While many people consider psoriasis to be a skin disease, it can also spread to nails, causing cracks, discoloration, and a rough texture. Nail psoriasis can be very difficult to treat, and it can take up to a year for your nails to return to normal. Fortunately, there are a wide range of treatments you can use to help strengthen and replenish your nails. Since nails with psoriasis tend to be more delicate, it is important that you take good care of your nails while undergoing treatment.
Steps
Method 1
Method 1 of 3:
Treating Nail Psoriasis
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1Visit your primary care physician or dermatologist. A doctor can prescribe special medications and provide injections to help treat your nail psoriasis. They can also determine if there is a fungal infection affecting the condition of your nails.[1]
- Your doctor will examine the condition of your nails. They may look for signs of nail psoriasis, such as pitting, thickened nails, gaps under the nail, and discoloration.
- Your doctor may send fingernail clippings to be tested for a fungal infection. While not all nail psoriasis is affected by fungus, a fungal infection can worsen symptoms.
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2Apply a corticosteroid ointment at night. Your doctor may prescribe a strong steroid or recommend a weaker over-the-counter version. Apply the steroid over the entire nail before going to bed. Rub it over the nail bed, which is located under the cuticle at the bottom of the nail. Wrap your nails with plastic wrap to prevent the ointment from rubbing off in your sleep.[2]
- Do not use corticosteroids for more than 2 weeks at a time unless directed by your doctor.
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3Apply other topical medications to your nail. In addition to corticosteroids, your doctor may prescribe another medicated ointment, cream, or gel. Apply these once or twice a day to the affected areas of your nail. Follow your doctor’s instructions for taking these medications. Topical treatments that might be used include:[3]
- Vitamin D3 derivatives
- Retinoids
- Anthralin
- 5-Fluorouracil
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4Undergo injections on your fingers or toes. These injections only need to be done every 4-6 weeks. Your doctor will spray a local anesthetic onto the nail. Once the area is numbed, the doctor will inject the medicine under your nail.[4]
- Your doctor may give you a medication called Triamcinolone. Biologics, like Infliximab, are also administered this way.
- Always have a medical professional administer your medication.
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5Undergo phototherapy. Psoralen plus ultraviolet light A (PUVA) therapy works by exposing your nails to ultraviolet light.[5] Before the procedure, your doctor will soak your hands and feet in a solution called Methoxsalen. Stick your hands or feet into the PUVA device to expose them to UVA rays.[6]
- Instead of soaking your nails, the doctor might give you a pill or apply a lotion. These are less common for nail psoriasis, however.
- In some cases, you might stand in a large, full-body booth for UVA exposure. Wear the goggles provided to you by your doctor.
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6Remove severely cracked, pitted, or discolored nails. If your entire nail is affected by psoriasis, your doctor may remove the entire fingernail. This is done to encourage regrowth of a healthy nail. The doctor will apply a urea solution to dissolve the nail. Once it is softened, the doctor will remove the nail.[7]
- It may take up to a week for the urea treatment to dissolve the nail fully. Fortunately, this treatment is painless, and the nail may fall off on its own.
- It can take 3-6 months for your nail to grow back completely after this treatment.
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7Try systemic therapy for severe nail psoriasis. Systemic treatment is medication that treats your entire body, not just your nails. These are usually pills or injections. If you have psoriasis on other parts of your body or if your nail psoriasis is severe, your doctor may recommend 1 of these treatments.[8]
- Examples of systemic treatments that might be used include methotrexate, retinoids, and cyclosporine.
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8Treat a fungal infection with an antifungal ointment or pill. Nails with psoriasis may be more susceptible to fungal infections. If you have a fungal infection, your doctor will prescribe an antifungal medication, depending on the type of fungus it is. Take the medication according to the instructions on the label.[9]
- Treating the fungus will not make nail psoriasis go away, but it will prevent the nail’s condition from worsening.
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Method 2
Method 2 of 3:
Caring for Your Nails
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1Soak your nails in warm, soapy water to clean them. Avoid cleaning under your nails with a pick or cotton swab, as it can cause the nail to lift up from the bed. If you have dirt under your nails, soak the nails in warm, soapy water for 5-10 minutes. This will remove most dirt without damaging the nail.[10]
- Dry your nails afterwards by gently patting them down with a towel until they are dry.
- Wash your hands in favor of using alcohol-based sanitizers when possible, as these can dry your hands and nails. Follow up with a moisturizer.[11]
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2Clip nails down so that they are short. Longer nails may break or injure more easily. Keep your nails down to the finger or toe. Use nail clippers or scissors to keep them short. Try to clip your nails once every 1-2 weeks, depending on how fast they grow.[12]
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3Remove any hangnails as soon as you find them. Clip off hangnails with a pair of nail clippers or scissors. Go down to the root of the hangnail, as close to the skin or nail as possible. Do not bite or pull the hangnail off.[13]
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4Buff the surface of the nail gently with a file. Take an emery board, foam nail buffer, or nail file. Place it flat against the nail. Gently move it back and forth to buff your nails. File the edges of your nails so that they are smooth. Do not apply much pressure. Just try to smooth out the surface of the nail.[14]
- If you feel pain or if you nail starts to crack more, stop filing. Try again another day.
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5Apply a moisturizer to your hands and nails daily. Moisturizer can prevent the nails from drying out. Hand or nail moisturizers that contain oils may be especially helpful. Make sure to rub these into the nail bed near the cuticle.[15]
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6Avoid clipping or pushing back the cuticles. The nail bed lies under the cuticles, and it is usually the part most affected by psoriasis. Try not to interfere with your cuticles. If you get a manicure, tell the technician that you do not want your cuticles clipped or pushed back.[16]
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7Apply nail polish to improve the look of the nail. Nail polish won’t damage your nails, but it can cover up any discoloration or rough texture. Choose clear polish if you want to make your nails look smoother or healthier. Wear a colored polish to hide discoloration.[17]
- Do not wear fake or acrylic nails, as they can worsen the psoriasis on your natural nail.
- If you notice your nails look dry or cracked after using nail polish, take a break. A non-acetone nail-polish remover will be gentlest on your nails.[18]
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Method 3
Method 3 of 3:
Preventing Further Damage
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1Keep your nails dry whenever possible. While you can wash your hands or take a shower, make sure that you always dry off your hands and feet, taking special care to gently pat down the area around your nails. Damp nails can increase your risk of fungal infection.[19]
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2Wear gloves during chores and tasks that use your hands. While the psoriasis is healing, your nails may be especially vulnerable to damage. Rubber or fabric gloves can help protect your nails if you’re engaged in manual activity. For example, always wear gloves when:[20]
- Washing the dishes
- Working in the garden
- Lifting heavy objects
- Cleaning with chemicals
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3Wear large shoes if your toenails are affected. If you feel pain or discomfort while walking, try wearing a pair of shoes that are half a size or a full size larger than normal. This will leave more room in the toe area so that your nails are not affected.[21]
- If your toes rub up against a pair of shoes, they may start to thicken, which will worsen the psoriasis.
- If your toenails are severely affected, a podiatrist may be able to prescribe you special shoes to wear. These shoes will prevent further trauma to the nail. Your primary care physician can refer you to a podiatrist.
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4Stop biting your nails. Biting your nails can cause more trauma to the nail, and it may worsen the appearance of psoriasis on your nail bed. If you have a nail biting habit, try to quit. Chew gum or squeeze a stress ball when you feel the urge to bite your nails.[22]
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5Try an autoimmune-friendly diet. Keep your nails looking their healthiest by strengthening your immune system. Certain dietary choices, such as pursuing a low-gluten, low-dairy diet rich in vitamin D, can help improve psoriasis of the fingernails.
- Because psoriasis is an inflammatory disease, avoiding foods that cause inflammation can ease symptoms.
- Try to incorporate offal, such as kidneys and liver, into your diet as well as fermented foods like sauerkraut or kimchi.[23]
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Warnings
- Nail psoriasis is considered the most difficult form of psoriasis to treat. You may need to try several different treatments before you find 1 that works for you.⧼thumbs_response⧽
- It can take up to a year or more for the nail psoriasis to disappear.⧼thumbs_response⧽
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References
- ↑ https://www.mayoclinic.org/diseases-conditions/psoriasis/expert-answers/nail-psoriasis-treatment/faq-20230374
- ↑ https://emedicine.medscape.com/article/1107949-overview#a10
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833799/
- ↑ https://emedicine.medscape.com/article/1107949-overview#a13
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833799/
- ↑ https://www.dermnetnz.org/topics/puva-photochemotherapy/
- ↑ https://emedicine.medscape.com/article/1107949-overview#a15
- ↑ https://www.mayoclinic.org/diseases-conditions/psoriasis/expert-answers/nail-psoriasis-treatment/faq-20230374
- ↑ https://dermnetnz.org/topics/nail-psoriasis/
- ↑ http://www.papaa.org/further-information/nail-psoriasis
- ↑ https://www.huffingtonpost.com/2015/04/21/do-nails-breathe_n_7087158.html
- ↑ https://www.cdc.gov/healthywater/hygiene/hand/nail_hygiene.html
- ↑ https://www.mayoclinic.org/diseases-conditions/psoriasis/expert-answers/nail-psoriasis-treatment/faq-20230374
- ↑ https://www.psoriasis.org/about-psoriasis/specific-locations/hands-feet-nails/managing-nail-psoriasis
- ↑ https://www.mayoclinic.org/diseases-conditions/psoriasis/expert-answers/nail-psoriasis-treatment/faq-20230374
- ↑ https://www.psoriasis.org/about-psoriasis/specific-locations/hands-feet-nails/managing-nail-psoriasis
- ↑ https://www.psoriasis.org/about-psoriasis/specific-locations/hands-feet-nails/managing-nail-psoriasis
- ↑ https://www.huffingtonpost.com/2015/04/21/do-nails-breathe_n_7087158.html
- ↑ https://www.mayoclinic.org/diseases-conditions/psoriasis/expert-answers/nail-psoriasis-treatment/faq-20230374
- ↑ http://www.papaa.org/further-information/nail-psoriasis
- ↑ http://www.papaa.org/further-information/nail-psoriasis
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833799/
- ↑ https://cdn.mdedge.com/files/s3fs-public/CT107006308.PDF
About This Article
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Medical Disclaimer
The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.
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