Nail Psoriasis: Complete Guide
Nail psoriasis guide: symptoms, causes, treatment, and selfcare tips. Learn how to protect your nails and when to see a doctor.
Written by Dr. Rohinipriyanka Pondugula
Reviewed by Dr. J T Hema Pratima MBBS
Last updated on 4th Dec, 2025
Introduction
Your nails can say a lot about your health. If you notice pitting, discoloration, lifting, or crumbling, you might be dealing with nail psoriasis. This common condition affects many people who have psoriasis on their skin or joints, and it can be painful, frustrating, and impact everyday tasks. The good news: effective treatments and smart nail care can help. In this complete guide, you’ll learn what nail psoriasis is, how to spot it, the latest treatments, and practical steps to protect your nails.
Consult a Top General Physician
What Is Nail Psoriasis?
Nail psoriasis happens when psoriasis affects the fingernails or toenails. Psoriasis is an immune-mediated condition that
speeds up skin and nail cell growth, causing thickening and changes to the nail and surrounding skin. Nail changes can
occur on their own, with skin psoriasis, or alongside psoriatic arthritis.
Key Facts
- Nail psoriasis is common in people with psoriasis and especially in those with psoriatic arthritis.
- It is not contagious.
- While there’s no cure for psoriasis, many treatments can reduce nail symptoms and improve nail appearance and
function over time.
Signs And Symptoms Of Nail Psoriasis
Nail psoriasis can look different from person to person. You may notice one or several of the following:
- Pitting: Small dents on the nail surface.
- Discoloration: Yellowbrown “oil drop” or “salmon patch” areas under the nail.
- Onycholysis: The nail lifts or separates from the nail bed, often starting at the tip; may look white or yellow
underneath. - Subungual hyperkeratosis: A chalky, thick buildup under the nail that can be tender.
- Crumbling or brittle nails: Nails may break more easily.
- Ridging and deformity: Irregular nail growth with grooves or thickening.
- Splinter hemorrhages: Thin, reddish brown lines under the nail from tiny blood vessels.
- Tenderness or pain: Especially when pressure is applied to the nail or wearing shoes.
These changes can involve one nail or many and can affect both fingernails and toenails.
Causes And Risk Factors
Psoriasis Involves An Overactive Immune Response that speeds up skin and nail cell turnover and triggers inflammation. Factors that may raise the risk of nail psoriasis include:
- Having psoriasis on the skin
- Having psoriatic arthritis
- Nail trauma (repeated friction, biting, picking, harsh manicures)
- Family history of psoriasis
- Smoking or certain infections can worsen psoriasis in general
How Nail Psoriasis Is Diagnosed?
A healthcare professional—often a dermatologist—usually makes the diagnosis based on your nail’s appearance and
your medical history. They may:
- Examine all nails and skin for psoriasis signs
- Ask about joint pain, stiffness, or swelling (possible psoriatic arthritis)
- Use a tool like NAPSI (Nail Psoriasis Severity Index) to track severity
- Test for fungal infection (nail clipping, KOH prep, or culture), because nail fungus can mimic or coexist with nail
psoriasis
Getting the diagnosis right matters because treatment differs for psoriasis vs. fungus—and sometimes both need treatment.
Treatment Options For Nail Psoriasis
Because nails grow slowly, improvement takes time. Fingernails may need several months to show changes; toenails
often take longer. Your plan may combine home care with medical treatments.
Topical Treatments (Applied To Nails And Surrounding Skin)
- Corticosteroids: High-potency steroid solutions, ointments, or foams can reduce inflammation, especially around the
nail folds and cuticle. - Vitamin D analogs: Calcipotriene (calcipotriol) or calcitriol can help regulate cell growth.
- Retinoids: Tazarotene gel or cream can reduce thickening and pitting.
- Calcineurin inhibitors: Tacrolimus or pimecrolimus creams may help near the nail folds, especially when long-term
steroid use is a concern. - Tips for use:
- Apply to the cuticle and nail folds where the nail grows (the “matrix” area), as directed by your clinician.
- Use regularly and be patient—results are gradual.
Injections And Procedures
- Intralesional corticosteroid injections: Tiny amounts of steroid injected into the nail matrix or bed can target stubborn
pitting or thickening. These are done by specialists. - Nail debridement: Trimming/filing the thickened nail and removing debris under the nail can reduce pressure and pain.
- Treat coexisting fungus: If confirmed, antifungal treatment may be added.
Light Therapy (Phototherapy)
- Targeted phototherapy (e.g., excimer laser/light) or PUVA may help selected patients. Nails can be less responsive
than skin, and availability varies.
Systemic And Biologic Medicines (For Moderate To Severe Cases Or When Joints/Skin Are Involved)
If nail psoriasis is severe, widespread, painful, or linked with skin plaques or psoriatic arthritis, your clinician may
consider medicines that work throughout the body:
- Oral/systemic agents: Methotrexate, cyclosporine, acitretin
- Biologics: TNF inhibitors (e.g., adalimumab, etanercept, infliximab), IL17 inhibitors (e.g., secukinumab, ixekizumab),
IL23 inhibitors (e.g., guselkumab, risankizumab), IL12/23 inhibitor (ustekinumab) - Other options for psoriasis and psoriatic arthritis: Apremilast (PDE4 inhibitor) and certain JAK pathway–targeting
treatments, based on indications - These therapies can improve both skin and nail symptoms and may be especially helpful if you also have joint
symptoms.
Home Care And Lifestyle Tips For Nail Psoriasis
Daily habits can protect your nails, reduce pain, and boost treatment results:
- Keep nails short and smooth: Trim straight across and gently file to prevent catching or lifting.
- Moisturize often: Use thick creams or ointments on nails, cuticles, and surrounding skin to reduce brittleness.
- Protect your hands: Wear cottonlined gloves for wet work, cleaning, dishwashing, gardening, or handling chemicals.
- Avoid nail trauma: Limit picking, biting, or aggressive manicures. Don’t clean deeply under the nail.
- Minimize water exposure: Prolonged soaking softens nails; dry thoroughly after washing.
- Choose gentle products: Fragrance-free moisturizers; avoid harsh removers or adhesives when possible.
- Manage triggers: Stress reduction, smoking cessation, and managing infections can help overall psoriasis control.
- Footwear matters: For toenails, choose roomy shoes and breathable socks to reduce pressure and moisture.
Nail Care And Cosmetics: What’s Safe?
Delving into the essentials of nail care and cosmetics, let's explore what is truly safe for your routine:
- Nail polish: Regular polish is generally safe; use acetone-free removers to limit dryness. If nails are lifting (onycholysis),
avoid polish getting under the nail. - Artificial nails (acrylic/gel): Can add weight/trauma and sometimes irritate skin. If you use them, choose light, short
extensions, and a salon that uses gentle techniques and maintains strict hygiene. - Manicures/pedicures: Inform your nail professional about nail psoriasis. Ask for gentle handling; avoid cutting cuticles,
which protects against infections.
Nail Psoriasis Vs. Nail Fungus
These conditions can look similar. Clues and considerations:
- Nail psoriasis: Pitting, “oil drop” discoloration, ridges, nail lifting, tenderness. Often seen with skin plaques or a family history of psoriasis.
- Nail fungus (onychomycosis): Thick, crumbly, discolored nails with debris; more common on toenails; can cause odor.
- Both can coexist: Testing a nail sample helps guide treatment. Treating fungus won’t fix psoriasis and vice versa, so
getting the right diagnosis is essential.
When To See A Healthcare Provider?
Make an appointment if you have:
- New or worsening nail changes (pitting, thickening, lifting, pain)
- Signs of infection: Increased redness, warmth, swelling, pus, or severe tenderness
- Suspected fungal infection or nail trauma that doesn’t improve
- Joint symptoms: Swollen or tender joints, heel pain, dactylitis (“sausage” swelling of fingers/toes), or morning stiffness
lasting more than 30 minutes - Significant impact on daily tasks, walking, work, or quality of life
Living With Nail Psoriasis: Coping And Support
Understanding and navigating the daily realities of nail psoriasis is essential for effective coping and finding the right support.:
- Set realistic expectations: Nails grow slowly—improvement often takes months.
- Track progress: Photos every 4–8 weeks can help you and your clinician see changes.
- Team up with a specialist: Dermatologists and, if needed, rheumatologists can tailor treatments, especially when joints
are involved. - Mental wellbeing: Nail changes can affect self-esteem. Support groups and counseling can help you cope and stay on
track with care.
Consult a Top General Physician
Consult a Top General Physician
Dr Summaiya Banu
General Practitioner
8 Years • MBBS
Hyderabad
Apollo 24|7 Clinic, Hyderabad
(225+ Patients)
Dr. Rajib Ghose
General Physician/ Internal Medicine Specialist
25 Years • MBBS
East Midnapore
VIVEKANANDA SEBA SADAN, East Midnapore
Dr. Harshendra Jaiswal
General Physician/ Internal Medicine Specialist
12 Years • MBBS , MD (General medicine)
Kolkata
108 DHANA DHANVANTARI Clinic, Kolkata
(25+ Patients)
Dr. Sourav Kundu
General Physician/ Internal Medicine Specialist
9 Years • MBBS , MD (General medicine)
Kolkata
HealthYou Speciality Clinic & Diagnostics., Kolkata
Dr Venkata Naga Sai Tribhushan Rambhatla
General Physician
3 Years • MBBS
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Consult a Top General Physician
Dr Summaiya Banu
General Practitioner
8 Years • MBBS
Hyderabad
Apollo 24|7 Clinic, Hyderabad
(225+ Patients)
Dr. Rajib Ghose
General Physician/ Internal Medicine Specialist
25 Years • MBBS
East Midnapore
VIVEKANANDA SEBA SADAN, East Midnapore
Dr. Harshendra Jaiswal
General Physician/ Internal Medicine Specialist
12 Years • MBBS , MD (General medicine)
Kolkata
108 DHANA DHANVANTARI Clinic, Kolkata
(25+ Patients)
Dr. Sourav Kundu
General Physician/ Internal Medicine Specialist
9 Years • MBBS , MD (General medicine)
Kolkata
HealthYou Speciality Clinic & Diagnostics., Kolkata
Dr Venkata Naga Sai Tribhushan Rambhatla
General Physician
3 Years • MBBS
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Frequently Asked Questions
1. Is nail psoriasis contagious?
No. Nail psoriasis is an immune-mediated condition and cannot spread from person to person.
2. Can I have nail psoriasis without skin psoriasis?
Yes. Some people develop nail changes without noticeable skin plaques. Nail psoriasis is also common in people with psoriatic arthritis.
3. How long does treatment take to work?
Nails grow slowly, so it can take several months to notice improvement. Fingernails typically show changes sooner than toenails. Consistent treatment and gentle nail care are key.
4. Will nail psoriasis go away?
Psoriasis is a long-term condition with periods of flares and improvement. Many people can keep nail symptoms under control with appropriate treatments and selfcare.
5. Do vitamins or supplements help nail psoriasis?
There’s no strong evidence that specific vitamins cure nail psoriasis. Eating a balanced diet supports overall health. Talk with your clinician before starting supplements, especially if you take other medications.