TOE NAIL AND FINGER NAIL PSORIASIS TREATMENT
When nails are affected by psoriasis it is known as psoriatic nail disease. It affects both finger and toe nails and usually affects persons with psoriatic arthritis and the elderly. In psoriatic arthritis, the patients experience symptoms of both psoriasis and arthritis. The finger nails are more affected than toe nails.
Nail psoriasis is seen as pitting and thickening of nails with an irregular contour. If left untreated in severe cases it can lead to problems, both social and functional.
The exact cause of nail psoriasis is unknown. It is believed to be a combination of genetic, environmental and immunologic factors as with other types of psoriasis.
Persons affected by nail psoriasis also usually have skin symptoms. If no skin symptoms are visible, then diagnosis becomes difficult. Nail psoriasis can also be seen along with fungal infections of the nail (onychomycosis) and inflammation around the edges of the nail (paronychia).
There are various symptoms connected to nail psoriasis:
- Discoloration. Yellow-red discoloring which resembles a drop of oil or blood under the nail plate. It is also known as an oil drop or a salmon patch.
- Pitting. The nail matrix develops pits due to the loss of surface cells.
- Thickening. The skin under the nail thickens and causes loosening of the nail.
- Loosening. The nail separates from the skin underneath it causing a white patch to develop. It starts from the tip and goes towards the root and the nail bed may also be infected. Medically this condition is known as onycholysis.
- White areas. These may appear on the nail plate.
- Lines across the nail. Also called “Beau lines”, they run across the nail horizontally rather than vertically.
- Crumbling. The nail crumbles due to weakness.
- Redness of lunula. The half moon-shaped white area of the bed of the nail or lunula becomes red and spotted due to congestion of the capillaries.
- Black lines. Tiny black lines appear on the nail horizontally. Also known as splinter hemorrhages, they occur when the capillaries at the tips of the fingers bleed between the nail and the skin.
- Arthritis. Changes in the nails are seen in people affected by arthritis of the fingers.
Nail psoriasis is considered to be the most difficult psoriasis to treat. Various types of treatment are used to treat the condition. Since nails grow extremely slowly it may take a long time for treatment to take effect. It may take one year for finger nails and up to two years for toe nails to grow out.
- Injections. Steroids are injected under the nails.
- Topical steroids. These are rubbed into the cuticle to reach the nail bed and improve the condition. They include salicylic acid and calcipotriol.
- Antifungal. If there is fungal nail infection present it has to be treated too.
- Phototherapy. Photo or light therapy along with psoralen is effective in the treatment of some types of nail psoriasis.
- Nail removal. A high concentration of urea is applied to the nail under polythene occlusion. This makes the nail jelly-like making it easy to peel off. Nails can also be removed surgically.
- Vitamin D analogues. These creams and ointments are massaged into the cuticle twice a day. This has proved to be an effective form of treatment.
Nails of both the hands and feet should be kept short. They should be trimmed back to the point where they are firmly attached and gently filed.
Keep the nails dry.
Protect the nails from damage. This can be achieved by wearing gloves when doing work that could cause damage.
Nail hardeners or varnishes could be used to improve the appearance of pitted nails.
The nails and cuticles should be kept moisturized by massaging them with moisturizers or soaking them in oil.
Toe nails could benefit by soaking them in warm water for ten minutes to soften them. They can then be filed gently with an emery board to remove the thickened parts. Nails should be cut straight across to prevent them from becoming ingrown. Friction to the toe nails should be avoided to cause thickening. This can be taken care of by wearing comfortable shoes with ample room for the toes and choosing shoes which are a size bigger. A podiatrist should be consulted in the case of painful toenail psoriasis.