- Psoriasis is auto-immune chronic disease.
- Symptoms can vary from mild to severe.
- Nail psoriasis also known as psoriatic nail dystrophy. It is due to psoriasis involving the nail matrix resulting in specific and non-specific changes occur in the nail.
- Usually skin cells reproduce every 28–30 days.
- When people has plaque psoriasis their immune system is overactive and causes cells to reproduce every 3–4 days. As a result visible sections of skin are thick, red, and itchy.
SIGNS OF NAILS PSORIATIC
- pitting, which involves dents or holes forming in the nail
- white spots on the nail
- grooves across the nail
- a change in the nail’s shape or size
- thickening of the nail
- separation of the nail from the nail bed
- crumbling nails
- discoloration, in which the nail may become yellow or brown, for example
- blood under the nail
CLINICAL SIGNS OF NAIL BED INVOLVEMENT
- Oil-drop sign and salmon patch
- Subungual hyperkeratosis
- Splinter haemorrhages under the distal third of the nail plate
OTHER CLINICAL SIGNS OF PSORIATIC NAILS
- Paronychia due to periungual psoriasis
- Acrodermatitis continua of Hallopeau
- Twenty-nail dystrophy
WHAT ARE THE COMPLICATIONS OF NAIL PSORIASIS?
- Secondary onychomycosis in the damaged nail plate
- Psychosocial effects impacting social relationships and work-related activities
- Association with psoriatic arthritis and metabolic syndrome.
WHAT IS THE DIFFERENTIAL DIAGNOSIS FOR NAIL PSORIASIS?
- Nail trauma
- Lichen planus of the nail
- Parakeratosis pustulosa
WHAT IS THE TREATMENT FOR NAIL PSORIASIS?
- Minimise nail trauma, keep affected nails short
- Treat associated onychomycosis first for at least three months
- Topical steroids — betamethasone dipropionate, clobetasol propionate
- Topical calcipotriol
- Topical calcineurin inhibitors
- Biological agents for psoriasis — infliximab, adalimumab, etanercept, ustekinumab
- Novel small molecules — apremilast, tofacitinib
- Photodynamic therapy
PREVENTION OF NAIL PSORIASIS
- Keep your nails trimmed short.
- Use a nail file to keep nail edges smooth.
- Wear gloves to clean and do other work with your hands.
- Moisturize your nails and cuticles every day and after they’ve been in contact with water.
- Wear comfortable shoes with enough room for your toes.
Dr. Vaidya Karanvir Singh is the younger Vaidya in Chandigarh Ayurved & Panchakarma Centre. He is the fourth generation in his family who is practicing as a general consultant in Ayurved & Panchakarma treatment at Chandigarh. In his practice, he had treated more than 1 Lakh Plus patients worldwide.