Nail psoriasis can be painful. It can also complicate daily tasks, such as putting on shoes, buttoning clothes, or typing. But treatment can help, and you have four different types to consider.

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Roughly 2% to 3% of people live with psoriasis, an autoimmune disease that causes your body to overproduce skin cells.

Estimates suggest that among people with psoriasis, up to half experience nail psoriasis. And as many as 90% of people with psoriasis will develop nail psoriasis at some point.

Nail psoriasis can cause a number of symptoms on your fingernails and toenails:

This condition can leave your nails, fingers, and toes tender and painful. You might notice changes in sensation when you touch things and have trouble doing daily tasks that involve your nails or fingertips.

Getting treatment for nail psoriasis can make a difference, but the best approach for you may depend on your specific symptoms and how severe they are.

Read on for an in-depth exploration of the four main treatment approaches for nail psoriasis.

Topical treatments are creams or ointments you apply directly to the affected area. Your specific symptoms will typically determine where you use the medication.

If you have symptoms that affect your nail itself, such as pitting, you’ll apply your medication on your proximal fold — where your skin meets the hard part of your nail. This will let the medication soak into the nail matrix underneath, which constantly grows and pushes out fresh nail.

If you have symptoms that mostly affect your nail bed, such as buildup, you’ll generally apply the medication onto the skin under your nail. Trimming your nails beforehand can help you get the medication in the right spot.

A dermatologist — a doctor who specializes in treating skin, hair, and nail conditions — will most likely recommend topical treatments if you have mild symptoms that only affect one or two nails. Options include:

Patience is key when using topical treatments. Since nails grow slowly, you’ll need to apply topical treatments once or twice a day for several months. You can use them yourself in the convenience of your own home, which many people consider a huge plus.

You’ll need a prescription for most topical treatments. Your insurance — including Medicare and Medicaid plans — will typically cover those prescriptions.

If topical treatments don’t help improve your symptoms, another option involves corticosteroid injections. Rather than applying medication on top of your skin, you can receive an injection directly into the affected area underneath. That way, none of the medication gets lost in transit.

Before your injection, the healthcare professional administering the injection will usually apply some local anesthetic to numb the area.

You can get these injections into each quadrant of the nail bed via the side of your finger or toe and into your nail matrix. Altogether, you may receive up to five shots per finger or toe, depending on how widely your nail psoriasis has spread.

Corticosteroid injections are safe, but they can cause temporary side effects such as:

  • a pins-and-needles feeling after the anesthetic wears off
  • blood under your nails
  • discoloration to the proximal fold — appearing brown, red, or purple, depending on your skin tone
  • proximal fold atrophy, when your skin retreats back from your nail

You can repeat this treatment once every 4 to 8 weeks until your symptoms improve. The number of sessions your insurance covers may vary, so it never hurts to check your coverage before making your treatment appointment.

A pulsed dye laser can burn away diseased cells with minimal harm to the surrounding healthy tissue. During treatment, a doctor or dermatologist places a handheld device against your finger or toe. They’ll fire off a pulse of laser, which may feel like someone snapped a rubber band against your nails.

For most people, this procedure feels less painful than injections, and you can treat any lingering soreness with an ice pack. You may also notice some bruising or dots of blood where the laser hit.

You’ll likely need three sessions, one per month, before your symptoms disappear for good.

Do other light therapy treatments work?

Other psoriasis therapies, such as photodynamic therapy, also use light. But these therapies work best on skin symptoms.

As of 2019, pulsed dye laser therapy is the only light therapy treatment recommended for nail psoriasis by the American Academy of Dermatology and the National Psoriasis Foundation.

Experts usually recommend this approach for moderate to severe nail psoriasis that involves:

  • nail crumbling or splitting
  • separation from the nail bed
  • symptoms that don’t respond to usual treatments

Pulsed dye laser therapy is typically quite effective for persistent symptoms, but it’s also expensive. Your insurance plan may not cover it unless you can prove topical treatments and injections haven’t worked for you.

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Systemic therapies refer to pills, tablets, injections, or infusions that carry medication to your whole body. These treatments can help with nail symptoms, but they may not work as well as the more targeted therapies mentioned above.

Insurance companies generally don’t cover systemic therapies for nail psoriasis, even severe cases, unless you also have some skin or joint symptoms.

A dermatologist or primary care doctor may prescribe systemic therapies in some cases, including the following:

  • You have extensive skin lesions as well as nail symptoms.
  • You have psoriatic arthritis.
  • Your symptoms affect four or more nails.
  • Your symptoms have a major effect on your quality of life.

Systemic therapies used to treat nail psoriasis include:

  • Otezla: This medication helps relieve inflammation by suppressing your immune system.
  • Biologics: These medications target specific parts of your immune system using living cells.
  • Cyclosporine (Gengraf, Neoral, Sandimmune): This medication helps lower inflammation by suppressing your immune system.
  • Methotrexate: This medication slows down the rate at which your body makes certain skin cells.
  • Retinoids: These topical compounds, derived from vitamin A, may help improve skin and nail health. You can purchase some retinoids over the counter, but a dermatologist or other doctor can also prescribe them in a stronger form.

Nail psoriasis isn’t life-threatening, but you generally don’t want to ignore the symptoms either.

As a general rule, you’ll want to talk with a primary care doctor, a dermatologist, or other skin care specialist as soon as you notice symptoms of nail psoriasis.

Untreated nail psoriasis tends to get worse, causing more and more damage to your nails over time.

Severe symptoms can:

  • expose tissue to bacterial or fungal infections
  • interfere with daily activities such as typing or walking
  • make some of your nails disappear entirely

What’s more, evidence suggests nail psoriasis may serve as a key risk factor for psoriatic arthritis. But timely treatment can delay the start of joint disease or prevent it from getting worse, which can save you a lot of pain.

Treatment for nail psoriasis usually involves visiting a dermatologist. If you already experience joint pain and other joint-related symptoms, it may also help to consult a rheumatologist. These doctors specialize in treating autoimmune conditions and diseases that affect your muscles, joints, or bones.

If you’re ready to find treatment, these tips can help:

  • Call your insurance company or search your plan’s website for dermatologists in your network.
  • Ask a primary care doctor for a referral to an in-network dermatologist.
  • If you don’t have insurance, call dermatologists in your area to ask if they offer payment plans, discounts, or other financial assistance.

Nail psoriasis symptoms such as nail splitting or skin cell buildup can cause pain and get in the way of your daily life, but treatment can help.

Often, topical treatments work well for mild symptoms. If you have moderate to severe symptoms, a healthcare professional may recommend injections, pulsed dye laser therapy, or systemic therapies.

When it comes to nail psoriasis and other autoimmune conditions, getting treatment as early as possible can help manage your symptoms and keep them from getting worse.

Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.