Fingernail Psoriasis

What is fingernail psoriasis? Nail psoriasis is the psoriatic involvement of the nail bed or nail matrix. It develops in 40-50% of patients after the onset of other forms of psoriasis. It may occur without cutaneous symptoms in 5-10% of the cases.

What are the symptoms of fingernail psoriasis?

Changes to the fingernails include:

  • Pitting, thickening, crumbling, of the nail matrix. Separation of the nail matrix from the nail bed may also occur.
  • Involvement of the nail bed may present with hyperkeratosis, salmon patch or oil spot discoloration, and splinter hemorrhages.

Nail psoriasis is a significant risk factor for the development of psoriatic arthritis and is an indication for evaluation of the same.


Treatment for fingernail psoriasis

Early treatment for nail psoriasis is important to prevent progression. Nail psoriasis can cause not only physical discomfort, but can be extremely embarrassing for the patient. Treatments for fingernail psoriasis include topical and systemic options that are prescribed based on severity, symptomatology, and tolerance.

  • Topical corticosteroids
  • Topical Vitamin D analogues
  • Topical tacrolimus
  • Topical tazarotene
  • Biologic TNF-alpha inhibitors
  • Oral or intralesional methotrexate
  • Pulsed dye laser

Gentle care of the fingernails, such as avoiding trauma, avoiding exposure to chemicals or wet environments by wearing protective gloves, keeping nails dry and trimmed, and applying emollients may prevent worsening of symptoms.

Source: Kaeley, G. S., Eder, L., Aydin, S. Z., Rich, P., & Bakewell, C. J. (2021). Nail Psoriasis: Diagnosis, Assessment, Treatment Options, and Unmet Clinical Needs. The Journal of Rheumatology, 48(8), 1208–1220.