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Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z





Nail psoriasis

What is nail psoriasis?

Nail psoriasis is nail disease associated with psoriasis. It is also known as psoriatic nail dystrophy.

Who gets nail psoriasis?

Only 5% of patients present with typical nail psoriasis as an isolated disorder; most patients have plaque psoriasis. About 50–80% have psoriatic arthritis, particularly arthritis mutilans.

Patients with nail psoriasis may be of any age or race. Nail dystrophy is often precipitated or aggravated by trauma.

What causes nail psoriasis?

Nail psoriasis arises within the nail matrix. The specific pathogenesis of nail psoriasis is unknown.

What are the clinical features of nail psoriasis?

Nail psoriasis can affect any part of one or more nails. There are often scaly plaques on the dorsum of the hands and fingers due to associated plaque psoriasis. Signs depend on the part of the nail affected. Its severity may or may not reflect the severity of the skin or joint psoriasis.

Nails in psoriasis Nails in psoriasis Nails in psoriasis
Psoriatic nails

More images of nail psoriasis ...

Complications of nail psoriasis

Nail psoriasis is unsightly. It can also lead to:

How is nail psoriasis diagnosed?

Psoriatic nail disease is readily recognised in a patient with current or prior plaque psoriasis. It is frequently confused with fungal nail infection. Fungal infection can also complicate nail psoriasis.

If in doubt, or antifungal treatment is planned, nail clippings and scrapings of subungual debris should be sent for potassium hydroxide microscopy and fungal culture.

A biopsy of the proximal nail matrix is occasionally needed to confirm the diagnosis of nail psoriasis, particularly if dystrophy affects a single nail and a tumour is a possible explanation. The biopsy can lead to permanent nail deformity.

What is the treatment for nail psoriasis?

It is difficult to treat nail psoriasis effectively.

Topical treatment must be applied to the nail matrix and hyponychium for months or years, and its effects are often disappointing. Options include:

Other options include:

Note: acitretin thins the nail plate and reduces its speed of growth, which can be helpful or not, depeneding on the type of nail psoriasis.

Topical and oral antifungal treatment may be prescribed if fungal infection is present.

Chemical or surgical avulsion therapy, i.e. complete removal of the nail, is occasionally recommended. A risk is that the regrowing nail may be as badly or more severely affected than prior to the procedure.

How can nail psoriasis be prevented?

At this time, we do not know how to prevent nail psoriasis. Avoidance of trauma is essential.

What is the outlook for nail psoriasis?

Nail psoriasis varies in severity over time. In some patients, it resolves completely spontaneously or as a response to systemic treatment. In others, it persists long term.

Related information

References:

  1. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Textbook of Dermatology. Fourth edition. Blackwell Scientific Publications.
  2. Cantoresi F, Caserini M, Bidoli A, Maggio F, Marino R, Carnevale C, Sorgi P, Palmieri R. randomized controlled trial of a water-soluble nail lacquer based on hydroxypropyl-chitosan (hPCh), in the management of nail psoriasis. Clinical, Cosmetic and Investigational Dermatology 2014:7;185-190

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Author: Vanessa Ngan, staff writer, 2003. Updated by A/Prof Amanda Oakley, February 2016.



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