Psoriasis and nails

Nail psoriasis reflects inflammation in the nail unit, which includes the nail plate, nail bed, and surrounding tissue. One nail or several may change, and fingernails and toenails can behave differently. Affected nails may become fragile or catch on clothing. Similar changes can follow repeated trauma or infection, so do not assume every altered nail is psoriasis. A full skin and nail examination gives useful context.

Trim nails carefully and smooth sharp edges rather than tearing them. Keep hands and feet moisturised, use protective gloves for cleaning, and choose comfortable shoes with room for the toes. Avoid removing debris with sharp tools and pause manicures or artificial nails if the surrounding skin is sore. If a clinician prescribes treatment, ask how to reach the nail bed or folds safely and use it for the recommended course.

Arrange an assessment for nail changes that persist, affect function, involve multiple nails, or occur with plaques on the skin. Get prompt help for pus, increasing warmth, marked swelling, severe pain, or a dark streak that changes or fails to move outward as the nail grows. New swollen joints or prolonged stiffness should be reported rather than attributed to nail disease alone.

Ask whether the nail needs a fungal test, whether psoriasis is affecting nearby skin, and which treatment is appropriate for the nail site. Ask how to monitor growth, protect the nail, and recognise infection or joint symptoms.