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Psoriasis is a common, chronic (long-term) skin condition that causes scaly and red patches to form which are often itchy and sometimes painful. The condition is a genetic autoimmune disease that can have episodes of flare-ups followed by resolution of symptoms. The scales are caused by cells building up on the skin. Nails and joints can also be affected by psoriasis.

There are different types of psoriasis, so symptoms can be slightly different depending on the type. Common symptoms of psoriasis include raised, red patches of skin called plaques which may be covered with a silvery scale.

  • Patches often occur on the scalp, elbows, lower back and knees.
  • Patches can itch and sometimes burn.
  • They can be small or cover large areas of skin.

Whereas, psoriatic arthritis can occur in people with skin psoriasis and affects joints, resulting in swelling, stiffness and tenderness. Many skin psoriasis and psoriatic arthritis sufferers experience nail changes such as thickening, nail pitting, crumbling, discoloration and sometimes separation of the nail from the nail bed.

Nail psoriasis occurs when nails are involved in psoriasis. What causes nail psoriasis, as with general psoriasis, is a combination of genetic and immune factors. Nail psoriasis typically occurs in people who have skin psoriasis and is strongly associated with psoriatic arthritis (only about 5% of those with nail psoriasis will have no other symptoms of psoriasis).  When nail symptoms are associated with psoriasis, it is sometimes referred to as psoriatic nail disease.

Nail psoriasis symptoms can often look very similar to fungal nail infections so it may be difficult to tell whether the condition is nail fungus or psoriasis. Psoriasis nail changes include:

  • Nail pitting
  • Thickening
  • Discoloration
  • Crumbling
  • Spots of blood under the nail
  • Separation of the nail from the nail bed

Fingernails are more often involved than toenails. Nail psoriasis typically occurs in people who have skin psoriasis – only about 5% of those with nail psoriasis will have no other symptoms of psoriasis. Nail fungus can occur on a nail with psoriasis because existing damage to a nail puts it at risk for a fungal infection. To be certain about what condition you have, it is best to consult a doctor.

While there are some over-the-counter products for relieving skin psoriasis symptoms like itching, redness, and scaling, those with more moderate to advanced psoriasis may seek medical treatment from their doctor. Treatments for general psoriasis include topical treatments such as steroids and vitamin D, as well as oral and injectable medications that can suppress the immune system. Light therapy is also used by doctors to treat general psoriasis.

Treatments options can have varying effectiveness in nail psoriasis. The best treatment for nail psoriasis will depend on how many nails are involved and what treatments have been tried. Your doctor may suggest using topical steroids or topical Vitamin D on the nails or sometimes local steroid injections around the nail area. If many nails are involved or if topical prescription therapy has not worked, oral or injectable medications may be used. Oral and injectable medications have greater side effects than topical prescription treatments – you can discuss this with your doctor to decide if it is right for you.

Nail psoriasis medications may need to be used for a long time before symptoms resolve and you see a change in the appearance of the nail. Once the nail is damaged, a new healthy nail needs to grow in and replace the damaged nail even when prescription treatments are being used.  It usually takes about 6 months to grow a new fingernail and 12 or more months to grow a new toenail.

Taking care of your hands and feet are important to manage the symptoms. This includes, avoiding trauma to the nail, wearing protective gloves when exposed to working in water or with harsh chemicals, keeping nails trimmed, drying nails thoroughly after bathing and regularly applying a cosmetic emollient.

A new cosmetic option that is available to help improve the appearance of nails damaged by psoriasis is Kerasal® Psoriasis Nail Repair™. This cosmetic treatment is available over-the-counter. It helps improve the appearance of nail psoriasis by reducing discoloration, normalizing thickness, smoothing the surface and hydrating brittle nails. It is applied topically to the nail and is clinically shown to start improving nail appearance after 1 week of use. After 8 weeks of use over 90% of users saw an improvement. Talk to your doctor about using Kerasal® Psoriasis Nail Repair™ with prescription oral or injectable treatments to help repair the appearance of the existing damaged nail.  It should not be used with other topical nail products. It is important to know that Kerasal® does not treat or cure the condition of psoriasis, but helps improve the appearance of nails damaged by psoriasis.