When psoriasis thickens, pits, ridges and discolors your nails, it’s hard to overlook.
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People often consider nail psoriasis mainly a cosmetic issue. But “nail psoriasis is a medical disorder that can be managed with various medications, often with good results,” says dermatologist Thomas Knackstedt, MD.
Topical medicine vs. injections
If your psoriasis is confined to the nail bed (below the “nail plates” you may polish), topical steroids, vitamin D3 analogue ointments, and retinoid creams or gels can be effective.
But psoriasis typically goes deeper, affecting the nail root (below the nail plate, cuticle and nail fold skin). While topical treatments do not penetrate the root of the nail, steroids can be safely injected around the nail with good efficacy.
“These injections are both safe and effective in reducing the pitting, hardening, ridging and discoloration, as well as nail separation, that psoriasis causes,” says Dr. Knackstedt.
Injections are usually given monthly. Dermatologists then reassess the nails to see if further treatments or dosage changes are needed.
If you can’t tolerate or don’t respond to injections, oral medications (such as cyclosporine, acitretin and methotrexate) are occasionally used — especially when you have psoriasis-related (psoriatic) arthritis or significant skin changes.
“Beyond that, we can offer biologic drugs,” says Dr. Knackstedt. “A systemic approach to treatment can be worthwhile, because many patients with skin psoriasis also have nail psoriasis, and both conditions increase the risk of psoriatic arthritis.”
The biologics used for nail psoriasis include infliximab, adalimumab, etanercerpt and ustekinumab.
More recently, a two-year study of the oral drug tofacitinib in over 1,800 patients with moderate-to-severe nail psoriasis showed significant improvement at four months that continued through one year. (One-quarter of these patients had psoriatic arthritis as well.)
Your nails need TLC
Whatever treatment you receive, it’s important to avoid irritating or injuring your nails. “Irritation and injury can drive the inflammation that drives psoriasis,” explains Dr. Knackstedt.
Avoid picking at your nails and manipulating them, and steer clear of harsh chemicals, such as those found in acetone and non-acetone nail polish removers.
“The progress for your nails may be slow. It can take three to six months before you see any improvement, says Dr. Knackstedt. “But most people do improve with the therapies available today.”