Psoriatic arthritis (PsA) is a type of arthritis that develops in people with psoriasis. It’s an inflammatory condition that causes joint pain, stiffness, and swelling. Most people develop psoriasis symptoms on the skin before they develop signs of PsA, though others notice arthritis symptoms first.
People with PsA often have symptoms that affect their nails. In addition, fingernail psoriasis is sometimes an early sign of PsA. According to the National Psoriasis Foundation, about 80 percent of people with PsA have fingernail psoriasis.
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 only have one or two.
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.
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.
PsA can also cause white spots on your nail. These tend to happen in the middle of your nail, and they indicate that you have psoriatic lesions in your nail matrix. This is the part of the nail bed where new nail cells are made.
For some, PsA can cause nail discoloration, causing your nails to look oil-stained. The exact color of these oil stains may vary, but they often have a pink or purple tint. They’re caused by a buildup of cellular debris beneath your nail.
Another sign of PsA occurs in the whitish half-moon near the base of your nail. 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, or flaking off layer by layer. Crumbling and flaking of the nail can happen as a result of inflammation or an overabundance of skin cells in your nail bed.
People with PsA sometimes develop vertical ridges running up and down their nails. These look like 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.
Splitting and crumbling can leave your nails vulnerable to bacteria and fungi. This can lead to paronchia, a nail infection, and nail fungus.
Symptoms of PsA in the nails usually respond well to general PsA treatments, particularly oral medications used to reduce inflammation and protect your bones against damage.
Common medications for PsA include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), help reduce inflammation and treat pain.
- Disease-modifying antirheumatic drugs (DMARDs). DMARDs, such as methotrexate (Trexall), leflunomide (Arava), apremilast (Otezla), and sulfasalazine (Azulfidine), work to prevent PsA from permanently damaging the joints.
- Biologic agents. Biologics are a new generation of arthritis drugs, formed through genetic engineering, that target inflammation in body.
There are also some treatments that work to target the nails directly, including:
- Cortisone injections. Cortisone injections usually target inflammation in a single joint, but they can also be given 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.
There are also several things you can do at home to help manage nail psoriasis, including:
- keeping your fingernails trimmed
- moisturizing your hands and feet with a gentle, fragrance-free moisturizer
- wearing gloves when doing manual labor or housework, such as washing dishes
- not soaking your hands and feet in very hot water, which can cause dryness
- using a soft-bristled nail brush instead of sharp objects to clean under nails
- not biting or picking at your nails and the skin around them
- carefully attending to hangnails and applying an antibiotic ointment when necessary
- ensuring any manicures or pedicures are done under sanitary conditions
- not wearing artificial nails
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.