Nails and toenails are often affected by psoriasis and psoriatic arthritis. Find out how to detect the signs and explore treatment options.
According to a study published in November 2014 in The Journal of Rheumatology , between 80 and 90 percent of people with psoriatic arthritis experience some nail damage. The effect of psoriatic arthritis on the nails and the nail bed is an often overlooked but potentially devastating complication of psoriasis and psoriatic arthritis.
“The involvement of nails in psoriatic arthritis can range from very minor nail bites to severe dystrophic changes in the nails,” says Neha Shah, MD, rheumatologist and clinical instructor in the immunology and rheumatology department at Stanford Health Care in Palo Alto, California “In addition to working with their rheumatologist to treat underlying psoriatic arthritis, which is the best way to treat nail involvement, patients should follow common sense nail care to help prevent trauma to the nail bed that could trigger more inflammation, such as wearing protective gloves during manual activities and closed shoes. ”
Nail signs are affected
A diagnosis of nail damage associated with psoriatic arthritis is usually made when the following symptoms are observed:
- Oil stains Nails appear to have oil deposits beneath the surface. The oil spots are yellow or brown and transparent.
- Nail bites produce small, round and randomly spaced dents on the surface of the nail.
- Salmon patches Pink or salmon patches on the nail bed are a hallmark of nail psoriasis.
- Onycholysis Psoriasis often produces nails that rise or separate from the nail bed.
In about a third of cases of nail psoriasis, a fungal infection is also present. It is important to recognize fungal infection and psoriatic nail abnormalities as two separate conditions, since the fungus could be exacerbating psoriasis, and eliminating the fungus will not necessarily eliminate changes in psoriasis nails.
Nail treatments can be tested individually or in combination. These include:
- Topical medications These treatments are applied directly to the nails and include corticosteroids, steroid-impregnated tape and cream-based medications with ingredients designed to retard cell growth. Topical treatment is usually applied at night and is sometimes more effective if a plastic wrap is placed over the medicated areas.
- Intralesional medication This nail care option consists of injecting steroids directly into the matrix of the affected nail, where the nail is formed. The inconveniences, the pain during the injection and the risk of atrophy in the surrounding area, often outweigh the benefits.
- The treatment with radiation X-ray surface sometimes been used to treat psoriatic nails, especially in certain European countries.
- Systemic medications Some medications Common systemic for psoriatic arthritis are Trexall (methotrexate) and Enbrel (etanercept). These medications are not usually a first-line treatment for psoriatic nails, but if a patient is taking these medications for psoriatic arthritis, they may also show some improvement in nail symptoms. According to Dr. Shah, other drugs are promising. “Cyclosporine and leflunomide used for six months showed some efficacy,” says Shah. “For the most effective and efficient treatment that generally gives most patients the results in three months, it is recommended that newer biological therapies (anti-TNF, anti-IL-17 and anti-IL-12/23) be used based on Results seen in clinical studies .. ”
- Phototherapy Some patients with psoriatic arthritis find relief with ultraviolet light directed at the nails. Psoralen, a medicine taken by mouth or painted on the nails, can increase the effectiveness of UVA treatment (the combination is called PUVA).
Daily care for nails.
Take a gentle approach with daily nail care to avoid flares:
- Go heavy on the FTA. Nails affected by psoriatic arthritis can break easily, and trauma can exacerbate or trigger an outbreak of symptoms.
- Keep nails short. Use manicure scissors to trim the nails back to the point where they are attached. Thick nails can be filed with an emery board. It is always a good idea, regardless of whether you have psoriatic arthritis, to present the toenails straight so that they do not become incarnate.
- Soak your nails in a tar bath. You can buy tar bath oil at your local pharmacy. Use three lids in a bowl of warm water and soak the nails for 20 minutes. Follow with a moisturizer.
- Protect your nails. While the nails are intact, you can apply a nail hardener or even artificial nails after discarding any allergic reaction to the chemicals and glues of these products.
Given the complex nature of nail psoriasis and the challenges to treat it, it is best to develop an attainable treatment plan and be prepared to try more than one strategy at the same time. Set realistic goals and understand that, due to the slow growth nature of the nails, it can take up to 12 months to see improvement.