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Free Beauty Tips Index => Psoriasis
Psoriatic Nails and You: Everything You Need to Know
by Louise Forrest
 
Psoriatic Nails are a form of psoriasis which affects the fingernails and/or toenails. High percentages of psoriasis sufferers are also affected with this disorder - 50% of people with psoriasis and 80% of people with psoriatic arthritis. Ranging from mild to severe and the severity, it is often indicative of possible permanent damage done to the nail matrix (the 'mother' of the nail).

In worst cases, there is much permanent damage done to the matrix and even when symptoms are controlled, the nail will still not grow and look like normal nails.
 
The nail problems most commonly experienced by psoriasis patients are:
Pitting - shallow or deep holes in the nail, layers of nail often peel away
Deformation - alterations in the normal shape of the nail, often wavy nails that have an abnormal curve in the tip of the nail
Thickening of the nail - nails are harder to clip/file and can lead to other issues
Onycholysis - separation of the nail from the nail bed evidenced by white areas under the nail plate. In extreme cases, the nail may come completely off.
Discoloration-unusual nail coloration that is not caused by an environmental source (chemicals, smoking, etc), often yellow or yellow-brown in color
 
Psoriasis of the nails can resemble other conditions such as chronic infection or inflammation of the nail bed or nail fold. When toenails are affected, they may resemble chronic fungal infection of the nails.
 
What Kind of Treatment Can I Expect?

Because the nail is affected during formation, psoriatic nails can be hard to treat. Like other types of psoriasis, there are a variety of options for treatment: topical (applied to outer surface), phototherapy, and systemic (injected or taken by mouth). It is important to realize that your nail will take about 6 months to grow from matrix to tip.

This means that even though you may have psoriatic symptoms under control, your nail will take a while to show the improvement as the damaged surface nail will have to grow off.
 
The major treatments specifically for nail psoriasis are:
Topical treatments - Dovonex, Tazorac, corticosteroids, steroid impregnated tape (Cordran), 5-fluorouracil
Intralesional - injection of steroids into each affected nail, quite painful and may or may not work for you.
 
Phototherapy-PUVA (psoralen + UVA rays), Psoralens are derived from plants and are applied to increase sensitivity to UV rays, helping to send symptoms into remission. UV rays are usually focused on the problem area though lasers.
 
Cosmetic repair - nails deformed by psoriasis may be removed surgically or with a strong urea compound. Long, thick nails can be scraped and filed down. Color changes can be covered with nail polish, and pitted nails can be buffed and polished. In some instances, artificial nails may be warranted.
Remember, with all treatments the nail will take about 6 months to grow out and be back to its normal state after treatment medication. For people who are already suffering severe psoriasis, treatment for psoriatic nails has to be coordinated with the treatments they are already taking:
Systemic treatments that are extremely effective for severe psoriasis would not require any change as they should also be effective on the psoriatic nails.
Oral retinoids, while effective on skin lesions, tend to make nails very thin.
A nail fungal infection, Onychmycosis, is often found in patients (about 33%) with psoriatic nails. This condition requires a separate antifungal oral medication. It is important to realize that both the fungus and the psoriatic nails must be treated. While the fungus may be triggering the psoriasis, treatment of the fungus alone may not be enough to clear the psoriasis symptoms.
People receiving PUVA treatments will most likely simply extend treatment area to the nails during normal treatment sessions.
Tarozac gel, a treatment specifically for psoriatic nails, significantly reduces separation of the nail from the nail bed with daily application.
 
At home care is important. Here are some steps to follow in your nail care regimen:
Trim nails to the point that they are firmly attached using manicure scissors.
Wear gloves while working with your hands
Soak nails in eight ounces of warm water with three capfuls of tar oil for 20 minutes, then dry and moisturize.
For intact nails, nail hardeners or artificial nails will improve appearance, but watch for reactions to glues and chemicals. With artificial nails, check for sensitivity before application.
Treat toenails to a soak like fingernails, using 3 capfuls of tar oil per every 8 oz of warm water, file or cut after soaking - softened nails are easier to cut and file.