Pie à la mode? Sounds good. Foot à la fungus? The worst. Are your toenails crumbling? Cracking? Discolored? Your nails might be trying to tell you something. You could unknowingly be walking around with nail fungus, or even psoriasis.

First up, what exactly is psoriasis?

Psoriasis is due to immune system dysregulation affecting the skin. Cells overproduce at a rapid rate, resulting in red, scaly lesions on the skin. Psoriasis isn’t contagious, but is often hereditary. However, the same can’t be said for nail fungus.

Enter nail fungus

Nail fungus (aka Onychomycosis) is a contagious infection that begins as white or yellow discoloration on the tip of your nail. It’s caused by fungi organisms — luckily not the mushrooms on your pizza.

As the fungal infection penetrates the skin under the nail bed, the nails begin to thicken and crumble.

Bottom line

Nail psoriasis and nail fungus share some common features, but they’re wildly different conditions. Each has its own specific treatment, so it’s important to know exactly what you’re dealing with.

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Nail psoriasis symptoms:Fungus symptoms:
nails turn yellow or brownthickening or deformation of the nails
small red or white spots are visible on the nail bedprogressive distortion in nail shape
pitting (small pinprick divots), thickening, or deformation of the nails.yellow and white streaks form on the nails
chalky white buildup under the nail, causing the nail to lift away from skin (subungual hyperkeratosis)nails become dark and discolored
nail begins to crumble off, usually starting at the tipassociated with concomitant athlete’s foot

Psoriasis psucks

According to the International Federation of Psoriasis Associations (IFPA), nearly 125 million people have psoriasis worldwide. That’s about 1.5 percent of the world’s population. It affects women and men at the same rate. Around half of those with psoriasis have nail psoriasis.

Nail psoriasis is more common on the toenails than the fingernails.

Symptoms may appear after an injury to the toes or fingers. Something as innocent as a stubbed toe may trigger a reaction.

The fungus among us

Nail fungus is both contagious and common. You can pick it up through physical contact with an infected person or object.

Fungal organisms have a field day in warm, moist environments. If fungi were conscious, they would daydream about warm, sweaty feet encased in running shoes.

Those with a weakened immune system (like with HIV/AIDs or diabetes) are more likely to contract a fungal infection. Elderly people are also more susceptible to nail fungus. Sorry, Grandma.

Early signs of a fungal infection include:

  • discolored nails
  • nails that begin to lift from the nail bed
  • brittle, thickened nails

Or, maybe Athlete’s foot has taken your little piggies hostage

Athlete’s foot (tinea pedis) occurs when a fungal infection affects the skin on your feet.

Signs of athlete’s foot include:

  • itchy blisters
  • dry skin on the soles and sides of the feet
  • burning and itching between the toes or on the soles
  • cracking, peeling skin on the feet

Toenail fungus infections can often arise from athlete’s foot.

Can you have psoriasis and toenail fungus?

Yes. Many people with nail psoriasis will also experience fungal infections. Unfortunately, there isn’t one medication to fight both at the same time since they’re completely different diseases.

Nail psoriasis can be difficult to treat. Topicals typically used in psoriasis, such as topical steroids, calcipotriene (a vitamin D cream), tazarotene (a vitamin A cream), and tacrolimus (a topical immunosuppressant) are not likely to help very much in nail psoriasis.

Other prescribed treatments that may be more successful include:

  • methotrexate, cyclosporine, and apremilast
  • corticosteroid injections to the nail bed
  • biologics

Treating nail fungus

There are countless antifungal topical creams, ointments, and oils on the market to combat nail fungus. For a more aggressive treatment, your doctor may prescribe antifungal pills in order to be more successful. Topical medications have a hard time penetrating to the source of the nail fungus.

These medications include:

  • fluconazole (Diflucan) — off-label
  • griseofulvin (Gris-Peg)
  • itraconazole (Sporanox)
  • terbinafine (Lamisil)

Keep in mind, treating nail fungus is a marathon, not a sprint

It can take up to a year for your nails to return to the original, healthy state. Fingernails grow faster than toenails.

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If you suspect psoriasis or have a family history of psoriasis, reach out to your healthcare provider. If you have a new, worsening dark discoloration on one nail in particular, though rarer, this can be a sign of melanoma of the nail.

If you suspect mild fungus, you may manage the symptoms with over-the-counter creams. If creams don’t improve symptoms in a few weeks, visit your healthcare provider. Nail fungus usually requires an oral prescription antifungal for successful treatment.

Good hygiene can’t prevent psoriasis, but it can help ward off fungal infections.

Fight the fungus with these tips:

  • Keep your nails trimmed and clean to prevent fungal growth.
  • Avoid cleaning under your nails with sharp tools.
  • Use nail moisturizers and oils to keep your nails healthy and soft.
  • Avoid tight shoes that cram toes together.
  • Don’t go barefoot in public (i.e. locker rooms, public pools, and public showers).
  • Keep your feet and hands dry.
  • Wear clean, breathable socks.
  • Avoid nail salons that do not adhere to proper sanitation standards.

Bottom line

  • Psoriasis is caused by immune system dysregulation. It’s a chronic condition with no cure. Symptoms can be managed with proper treatment.
  • Nail fungus is contagious but curable. If home treatments don’t work for you, talk to your doctor about stronger options.
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