How to Treat Nail Damage From Psoriatic Arthritis

Psoriatic arthritis (PsA) is best known for the damage it can do to your joints, but changes to your nails — both fingernails and toenails — can also signal that something is amiss inside your body.

Types of Nail Psoriasis and PsA Nail Damage

“Nail involvement in psoriatic arthritis can range from very mild nail pitting all the way to severe dystrophic nail changes,” says Neha Shah, MD, a rheumatologist and clinical assistant professor in the department of immunology and rheumatology at Stanford Health Care in Palo Alto, California. This can include extreme alterations in color and shape.

• Pitting Small, round, randomly spaced dents appear on the nail surface.
• Nail Shape Changes The nail plate forms differently than usual.
• Discoloration Nails are yellow-brown, pink, or purple.
• Thickness Nails grow thicker or feel “heavier” than normal.
• Separation (Onycholysis) Nails lift or separate from the nail bed.
• Onychomycosis This fungal infection can cause nails to become discolored or thick and separate from the nail bed.
• Beau’s Lines Nails develop horizontal ridges.

Medication for PsA Nail Damage

Doctors have a number of treatments for PsA-caused nail problems. They may utilize them individually or in combination.

• Topical Medications Placed directly on the nails, these drugs, which include corticosteroids, are designed to slow cell growth. You usually apply topical treatments overnight, sometimes placing plastic wrap over the medicated areas to make the drug more effective.
• Injectable Corticosteroids Doctors inject steroids directly into the affected nail matrix, where the nail forms. Injections are given every four to six weeks.
• Laser Therapy While more research is needed, one study found that a fractional CO2 laser followed by a topical medication may be an effective treatment for nail psoriasis.

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• Systemic Medications PsA treatments that work throughout the body may be appropriate for people with more severe disease and nail issues. Common systemic medications for PsA include biologics and methotrexate.

Nail Care for People With Psoriatic Disease

“Besides working with a rheumatologist to treat the underlying psoriatic arthritis, which is the best way to treat nail involvement, patients should follow common sense nail care to help prevent trauma to the nail bed that could trigger more inflammation,” says Dr. Shah.

• Keep nails short. Trim nails or file down thick toenails with an emery board. Whether or not you have PsA, file toenails straight across to prevent them from becoming ingrown.
• Avoid artificial nails. Nail polish is fine, but artificial nails can increase the chance of your nails separating from the nail bed, which can be a common issue with psoriasis.
• Wear gloves when doing manual labor or using soaps or chemicals. Gloves can protect nails from getting injured or irritated.
• Don’t bite or pick at your nails or the skin around your nails. This can harm your nails and increase the possibility of infection.

The Takeaway

• Psoriatic arthritis can cause notable changes to your nails, such as pitting and discoloration, signaling underlying health issues.
• There are several effective medication options for managing nail problems in psoriatic arthritis, including topical medications and injectable corticosteroids.
• Practice careful nail care, like keeping nails short, avoiding artificial nails, and protecting them from injuries, to minimize symptoms.
• If you notice significant or distressing changes in your nails, consult with a healthcare professional.

Additional research by Becky Upham.