If your nails are crumbling away or fading to brown like they have their very own sepia tone Instagram filter, then you may have nail psoriasis.
Psoriasis is a chronic condition that causes your body to produce more skin cells than it needs. The excess cells result in red, white, or silvery sore patches on your skin. Psoriasis can show up anywhere on your body including the chest, arms, legs, torso, and yes, even your nails.
More than 125 million people are living with psoriasis across the globe. That number makes up around 2 to 3 percent of the population, and even includes Kim Kardashian, Cara Delevingne, and LeAnn Rimes, so you’re in good company.
Around 50 percent of people with psoriasis will experience changes in their fingernails or toenails. Experts don’t know why some people experience nail symptoms while others don’t, but they do know it’s more likely to happen to your fingernails than your toenails.
Occasionally, some peeps experience psoriasis symptoms on their nails and nowhere else.
You’ll know something’s up if your nails look markedly different. Like that time in middle school when you stopped shopping at Limited Too and switched suddenly to Hot Topic, changes in nail health also signal a cry for help.
Here’s what to look out for.
Your nails change colors like a mood ring
In the case of nail psoriasis, the brown and yellow hues don’t indicate happiness.
Nail psoriasis initially appears as a yellow-red spot in the nail bed and may look like a drop of oil trapped under your nail.
Nails also commonly turn yellow-brown in color. Nails may turn white if they’re crumbling or separating from the nail bed.
They’re transforming into thimbles
Nail pitting is a symptom that gives your nails the textured look of old-school thimbles like grandma used while embroidering your Christmas sweaters. You could develop anywhere from 1 to more than 20 small pits on your nail surface.
Your nail and nail bed are “taking some time apart”
Nail bed separation, also called onycholysis, happens when the nail splits from the nail bed beneath it (more on that shortly). You’ll notice a white or yellowish patch on the nail that extends down toward your cuticle.
There’s mysterious chalky stuff under your nail
Subungual hyperkeratosis is a chalky material that gathers under your nail, making it raised and tender to touch. This can make squeezing into tight shoes extra painful if it occurs on your toenails.
Ch-ch-ch-ch-changes
Your nail’s overall shape and appearance can change, with the nails becoming thicker, misshapen, or crumbly.
Unfortunately, there’s no Amazon Prime for nail growth. So the main thing you’ll need in order to manage it is patience. Because nails grow so slowly, results can take several months to a year.
The upside is that there are plenty of options to try.
Topical treatments
If your symptoms are fairly mild, your doctor may prescribe topical treatments. Creams and ointments like calcipotriol, tazarotene, and tacrolimus are massaged into your cuticles to help reach the nail plates beneath them.
Biologics
Biologics, a new class of drugs that target the immune system, can be administered through infusion or self-injected.
Oral antifungal treatments
Fungal infections alongside nail psoriasis are fairly common. Your doctor might prescribe oral antifungal medications such as terbinafine or itraconazole.
Corticosteroid injections
Corticosteroid injections into the nail bed can help complement topical treatments.
Removing the nail
In some cases, your doctor might remove impacted nails. They could do this surgically, with x-ray therapy, or by applying concentrated urea to the nail.
Systemic treatments
If your psoriasis is severe, your doctor might prescribe systemic treatments, which impact your whole body rather than just your nails.
These treatments include medications like methotrexate, apremilast, and retinoids. These usually come into play if your nail psoriasis is intense enough to hinder walking or use of your hands.
Light treatments
Your doctor might suggest phototherapy, during which your affected nails are exposed to UVA rays.
Some people try to tackle symptoms with home remedies, like applying vinegar or garlic to the nails for their naturally occurring antifungal properties, but there’s little evidence to support their efficacy for psoriasis.
You’ll want to double check with your doctor before trying these home remedies because aside from not working, they can have unintended side effects.
The DIY option to amp up is your nail hygiene routine. Hygiene cannot prevent psoriasis, but it can help ward off accompanying infections.
Keep your nails hygienic by filing them short and moisturizing your cuticles. Avoid cleaning them with a nail brush or a sharp tool, because this can exacerbate nail separation and create more opportunity for infection.
Glamming up your nails
In the process of dealing with these symptoms, you might be tempted to give your nails a few cosmetic upgrades. That’s OK, but there are a few things to consider before heading to the salon.
Be warned! Nail salons can be a source of infection. You may be exposing your already-vulnerable nails to all sorts of fungus and bacteria.
If you do pretty up your nails, nail polish is totally fine, so go wild with the nail art if you so choose (#Bless). However, artificial nails are a big no-no while you’re experiencing symptoms.
And if you get a manicure, pass on having your cuticles pushed back, as this can make your symptoms worse.
Onycholysis: French tips gone rogue
Onycholysis is a common annoyance when dealing with nail psoriasis. It happens when your nail separates from the nail bed and creates an empty space under your nail. Sometimes, that little white strip at the top of your nail that is emphasized in French manicures, will extend all the way to your cuticle.
The separation creates a space between the nail and nail bed that’s vulnerable to bacteria. This can lead to a fungal infection called onychomycosis, which manifests as green patches on the nail. It’s usually treated with an antifungal medication.
Activities that aggravate your nails can increase separation, so you’ll want to make sure you’re taking it easy on them. (A good excuse to not do the dishes, amiright?)
Dry nails or minor nail injuries can happen to anyone, but when you have nail psoriasis, they can trigger a flare-up.
Keep your nails short so they don’t catch on anything. Wear gloves when you’re cleaning or working with your hands. Stop 👏🏼 biting 👏🏼 your 👏🏼 nails! Avoid cutting your cuticles or scraping the buildup under your nails.
Any symptoms of nail psoriasis call for a trip to the doctor. Finding a treatment that works for you may require significant trial and error, so the sooner you can get started, the better. You’ve got this.
Remember, psoriasis isn’t contagious. With new treatments popping up regularly, there are plenty of options to get your nails back in tip-top shape.