What is Nail Psoriasis & How do I Know if I Have It

Are your toenails or fingernails looking a little different lately? Are you noticing changes that include any of the following?

Colour change: Your nails may change colour to a greenish, yellow or brown colour. In some cases, there may appear to be red or white spots underneath.
Surface changes in the nail bed: Sometimes ridges or grooves in your nails, or what we call “pitting”, which look likes small pinprick holes also known as “oil-drops” on the surface of the nail plate.
Build-up of debris: This can look like chalky-white debris building up into the sides of the nails. Sometimes this extra debris can cause some pain and discomfort, because this process can cause the nail to lift.
Nail thickening, brittleness and breakage
Nail separating from the nail bed
Pain and tenderness in the nails (especially in the fingernails)

Sometimes fungal nails may be confused with psoriatic nails as they present with similar signs and symptoms; such as yellow discolouration, brittleness, thickening and separation from the nail bed. Unlike nail fungus, nail psoriasis is not contagious nor infectious.

Nail psoriasis is known to almost always occur in patients who have general psoriasis, and a distinctive factor is that it will almost always affect the fingernails before it affects the toenails. If you have psoriatic arthritis, it would be wise to visit your podiatrist, as the National Psoriasis Foundation states that at least 80% of patients with the condition will experience nail problems.

If this is something that you may be suspecting, it may be time to pay a visit to your podiatrist so that we ca help in making a conclusive diagnosis.

How is nail psoriasis diagnosed?

Typically, a definitive diagnosis of nail psoriasis is achieved through a biopsy, which is when a small portion of the nail is taken from the nail bed and sent for testing. This procedure is performed by a specialist and most of the time requires a GP referral. We can assist you by writing to your GP if we suspect psoriatic involvement in the nails.

Treatment options for nail psoriasis:

As podiatrists we use medial-grade instruments and tools to alter the condition of the nail surface to provide a comfortable environment for our patient’s feet. Since Nail Psoriasis requires a treatment regimen approved and prescribed by a GP, the medication aspect of this condition can be looked after by your local GP.

We also provide a grading of the severity of the psoriasis of the nails and treat each patient accordingly. We aim to keep the symptoms at bay and educate you on the best way to maintain optimal nail health in conjunction with your GP’s treatment.

A podiatrist can manage and improve the condition of the nails whilst medication is bein applied. A podiatrist is also very experienced in diagnosing and managing toenail conditions that I would highly recommend atleast a consultation to get an experts opinion on your toenails.

Dr Jessica Shehata (Podiatrist)