What Does Psoriasis of the Nails Look Like?

Is it treatable with a topical cream?

Doctor Answers 2

Treating psoriasis of nails

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Nail psoriasis affects many patients with psoriasis, and may be a predisposing sign of the development of psoriatic arthritis. The nails can lift ("onycholysis"), develop small dark lines ("splinter hemorrhages"), develop a brown stain ("oil drop sign"), or become thickened (sometimes because of psoriasis, other times because of a fungal infection). Topical steroids can be tried on the skin around the nail, as well as injecting steroids in the same area. If not responding, using acitretin, methotrexate or the new biologics are generally more effective treatments.

Toronto Dermatologic Surgeon

There are various presentations

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Thanks for your question.

Psoriasis of the nails can have many different appearances.

The most common is nail pitting - the appearance of tiny pits in the nail when looking at it straight on or in tangiential light.

The nails can also seperate from the nail bed (onycholysis) and have a whitish appearance at the tip of the nail that can spread down pretty close to the cuticle.

The nails can also appear crumbly or have debris gathering up underneath the nail.

There are other various signs, namely reddish-orange or white markings, that might represent nail psoriasis.

Nail psoriasis is often seen with psoriatic joint arthritis, however, some patients can just have the nail and skin manifestions or psoriasis, or just the nail psoriasis by itself. It is very important to see a dermatologist to confirm your diagnosis and to get treatment. Treatment of nail psoriasis is difficult, and is limited to topical creams (steroids), pills (acitretin / methotrexate), or intralesional steroid injections. The newer injectable medications are also helpful, but are usually only used for more severe skin psoriasis or psoriatic arthritis.

Hope this helps you understand a little more about nail psoriasis!

Don Mehrabi, MD
Beverly Hills Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.