Psoriasis under the nail: treatment options

Nail psoriasis can affect the nail plate, the skin beneath it, or the area where the nail grows. A nail may develop small pits, grooves, colour change, thickening, crumbling, or separation from the nail bed. Tenderness can make typing, walking, or handling objects difficult. Fungal infection can look similar, so an examination and sometimes a nail sample help guide the choice of treatment. Skin psoriasis elsewhere on the body or a family history can provide useful context.

Treatment depends on how many nails are involved, how much of the nail is affected, and whether psoriasis is also active on the skin or joints. A clinician may discuss medicine applied around or under the nail, injections near the nail, light-based treatment, or whole-body treatment when disease is more extensive. Nails grow slowly, so visible improvement may take time even after inflammation is controlled. Keep nails short, avoid picking or cutting the cuticle, wear gloves for wet work, and report new joint stiffness or swelling.

Arrange an assessment if a nail changes persistently, becomes painful, lifts, or repeatedly breaks. Seek prompt care for spreading redness, warmth, pus, marked swelling, fever, or severe pain, because these features can point to infection or another problem. Sudden painful swelling of a finger or toe, prolonged morning stiffness, or difficulty moving a joint deserves timely review because psoriasis can involve joints.

Ask whether the change is nail psoriasis, infection, trauma, or a combination; whether a sample is needed; which nail treatments fit the affected area; how long to use them; and what side effects should prompt a call. Also ask how to protect the nail during work and whether joint symptoms change the treatment plan.