Nail problems are a predictor of psoriatic arthritis as well as a common symptom, according to Francis C. Luk, MD, a rheumatologist at Wake Forest Baptist Health in Winston-Salem, North Carolina. He describes a condition called pitting: “It can look as though someone took a sharp pin and just punctured the nails multiple times. That’s a sign that psoriatic arthritis is going to develop, if it hasn’t already,” he says. According to a 2017 review published in the journal Reumatologia, approximately 80 percent of people with psoriatic arthritis experience some nail damage. The effect of psoriatic arthritis and psoriasis on nails and nail beds is an often overlooked but potentially devastating complication. The National Psoriasis Foundation describes different types of damage:
Pitting Nail pitting produces small, round, randomly spaced dents on the nail surface.Nail Shape ChangesDiscoloration Nails appear yellow-brown, pink, or purple.Thick Nails Nails grow abnormally thick and can lift or separate from the nail bed.Onychomycosis This fungal infection can cause nails to become discolored or thick and separate from the nail bed.Beau’s Lines Nails develop horizontal ridges.
According to the American Academy of Dermatology, options may include:
Topical Medications Placed directly on the nails, these drugs are designed to slow cell growth; they include corticosteroids, steroid-impregnated tape, and cream-based formulations. You usually apply topical treatments overnight, sometimes placing plastic wrap over the medicated areas to make the drug more effective.Intralesional Medication Doctors inject steroids directly into the affected nail matrix, where the nail forms. The drawbacks — pain during injection and risk of atrophy in the surrounding area — often outweigh the benefits.Laser Therapy This can sometimes be effective.Systemic Medications Psoriatic arthritis treatments that work throughout the body may be appropriate for people with more severe disease and nail issues. Common systemic medications for psoriatic arthritis include biologics, methotrexate, retinoid, cyclosporine, and apremilast.Phototherapy Ultraviolet light directed at the nails can help some people. Psoralen, a drug taken either by mouth or painted on the nails, can increase the effectiveness of UVA treatment (the combination is called PUVA).
Psoriatic disease can cause complex nail issues, so doctors may need to try different treatment strategies, and possibly more than one at the same time. The National Psoriasis Foundation suggests setting realistic goals; because nails grow slowly, it may take 6 to 12 months to see improvement. Nails affected by psoriatic arthritis can break easily, and trauma can exacerbate or trigger a flare-up of symptoms. Taking steps to protect your nails is key. The American Academy of Dermatology offers a few tips that can help:
Keep nails short. Use manicure scissors to trim nails, or file down thick toenails with an emery board. Whether or not you have psoriatic arthritis, file toenails straight across to prevent them from becoming ingrown.Strengthen nails. As long as your nails are intact, you may want to apply a nail hardener or even artificial nails. Just be sure you’re not allergic to the chemicals and glues in these products.Wear gloves when doing manual labor or using soaps or chemicals. Gloves can protect nails from getting injured or irritated.Don’t bite or pick at your nails or the skin around your nails. This can harm your nails and increase the possibility of infection.
Additional research by Becky Upham.
