Psoriatic arthritis (PsA) is a type of arthritis that develops in people who have psoriasis. It’s an inflammatory condition that causes joint pain, stiffness, and swelling.

Most people develop psoriasis symptoms on their skin before they develop signs of PsA, though others notice arthritis symptoms first.

People with PsA often have symptoms that affect their nails. In fact, fingernail psoriasis is sometimes an early sign of PsA. According to a research review published in 2017, about 80 percent of people with PsA have nail lesions.

Read on to learn more about how PsA can affect your nails.

PsA can cause a variety of nail issues. Keep in mind that not everyone with PsA experiences these problems, and others may have only one or two of these nail changes.

Pitting

Many people with PsA have nail psoriasis, which can result in pitting. This causes your nails to look like they have small holes or dents in them. They might also feel rough or bumpy to the touch.

Pitting happens when unusual cell growth causes a buildup of deposits on your nail. When these deposits fall off, they leave holes and dents.

Your nail will continue to grow around these areas.

Separation

PsA can cause your nail to separate from its nail bed. This may occur in small pockets or across your entire nail. When a small area of the nail lifts up off the nail bed, it may look like a clear or white spot.

Nail separation occurs as a result of inflammation in the nail bed.

White spots

PsA can also cause white spots on your nail. These tend to happen in the middle of your nail.

They indicate that you have psoriatic lesions in your nail matrix, which is the part of the nail bed where new nail cells are made.

Discoloration

For some, PsA can cause nail discoloration. This may cause your nails to look oil-stained. The exact color of these stains may vary, but they often have a pink or purple tint.

They’re caused by a buildup of cellular debris beneath your nail.

Red spots

Another sign of PsA occurs in the whitish half-moon near the base of your nail, known as the lunula. Some people with PsA develop red spots in this area, but no one’s sure why. These red spots may indicate the development of new blood vessels.

Crumbling or flaking

People with PsA may have nails that appear to be:

  • crinkling up
  • crumbling
  • flaking off layer by layer

Crumbling and flaking of the nail can happen as a result of inflammation or too many skin cells in your nail bed.

Ridges

People with PsA sometimes develop vertical ridges running up and down their nails. These look and feel like raised lines.

They occur when psoriatic lesions form in the nail matrix.

Splitting with purple spots

Splitting often goes hand in hand with ridges. Your nail may split vertically along one of the ridge lines.

If there’s a dark spot in the ridge, it could be a sign of a splitting hemorrhage. These occur when blood vessels break and leak blood into small splits in the nail.

Infections

Splitting and crumbling can leave your nails vulnerable to bacteria and fungi. This can lead to paronychia (a nail infection) and nail fungus.

PsA-related nail problems usually respond well to general PsA treatments, particularly oral medications used to reduce inflammation and protect your joints from damage.

Common medications for PsA include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help reduce inflammation and treat plain. This class of medication includes ibuprofen (Advil, Motrin) and naproxen (Aleve).
  • Disease-modifying antirheumatic drugs (DMARDs). DMARDs — such as methotrexate (Trexall), leflunomide (Arava), apremilast (Otezla), and sulfasalazine (Azulfidine) — work to prevent PsA from permanently damaging your joints.
  • Biologic agents. Biologics are a newer generation of arthritis drugs, formed through genetic engineering. They target inflammation in your body.

Some treatments work to target your nails directly, such as:

  • Cortisone injections. Cortisone injections usually target inflammation in a single joint, but they can also be injected into the nail bed to reduce inflammation and combat psoriatic lesions.
  • Steroid cream. Your doctor can prescribe a steroid cream for you to rub directly on your nails.
  • Light therapy. Light therapy (phototherapy) uses ultraviolet light to target psoriasis by slowing skin cell growth. It can be performed at home with special equipment or at your doctor’s office to treat psoriasis of the nails.
  • Antifungal medications. If you develop a fungal nail infection, your doctor might prescribe a topical antifungal cream.
  • Antibiotics. If you have a bacterial infection in your nail, you may need oral antibiotics.

Some home remedies can help alleviate symptoms of PsA in nails. Here are several things you can do to help manage nail psoriasis:

  • Keep your fingernails clean and trimmed.
  • Moisturize your hands and feet with a gentle, fragrance-free moisturizer.
  • Wear gloves when doing manual labor or housework, such as washing dishes.
  • Avoid soaking your hands and feet in very hot water, which can cause dryness.
  • Use a soft-bristled nail brush instead of sharp objects to clean under nails.
  • Avoid biting or picking at your nails and the skin around them.
  • Carefully attend to hangnails and apply an antibiotic ointment when necessary.
  • Ensure that any manicures or pedicures are done under sanitary conditions.
  • Avoid wearing artificial nails.

Always let your doctor know before trying any herbal or natural remedies such as turmeric to help reduce inflammation. The efficacy of herbal remedies hasn’t been proven.

Psoriasis of the nails can be an early sign of PsA, an inflammatory condition that can lead to other nail problems.

While some of these issues are unavoidable, taking care of your nails and protecting them against infection can help to reduce your risk.

If you see any signs of psoriasis or any fungal infections, tell your doctor. If you have psoriasis and notice new nail symptoms, your doctor can help diagnose and treat the areas.

Finding the right treatment and symptom relief takes time. However, new treatments are being researched every day that could bring relief.