Nails in psoriatic arthritis: what to know

Psoriatic arthritis may affect the nail unit, including the nail plate and the tissue beneath it. Small dents, ridges, crumbling, yellow-brown colour, or a nail lifting away from the skin can appear. These changes may happen with skin psoriasis, joint pain, joint swelling, or morning stiffness, but nail findings alone do not confirm a diagnosis. Fungal infection, injury, eczema, and other nail conditions can look similar.

Nail changes can be easy to overlook because they often develop gradually. Photographing them in natural light can help a clinician compare changes over time. Mention any tenderness at the end joints of the fingers or toes, because inflammation there can be linked with nail disease.

Arrange an assessment if new nail changes occur, especially if you also have persistent joint pain, swelling, or stiffness. Keep nails trimmed straight across, avoid cutting or pushing back the cuticles, and wear gloves for wet or chemical-heavy tasks. Do not scrape under a lifted nail or share nail tools. A clinician may examine the nails, skin, and joints and may test for infection before choosing treatment.

Treatment depends on the pattern and severity. Options can include anti-inflammatory medication for active inflammation and a coordinated rehabilitation plan when joint movement or hand function is affected. Nail improvement is usually gradual because healthy nail must grow out.

Seek prompt medical advice for a rapidly worsening nail, spreading redness, pus, marked warmth, severe pain, fever, or a dark streak that does not grow out. Urgent assessment is appropriate after a significant injury or if a finger or toe becomes very swollen and movement is difficult. Sudden loss of function should not be attributed to psoriasis without examination.

Could this be nail psoriasis, infection, or an injury? Do my nail findings fit with inflammation in a finger or toe joint? Would a skin or nail sample help? Which treatments are suitable if I have other medicines or health conditions? How should I protect the nail while it grows?