What should you know about psoriatic arthritis toenails?

A toenail may develop tiny depressions, roughness, grooves, yellow or brown colour, increased thickness, crumbling, or a gap between the nail and nail bed. Psoriasis-related inflammation can involve the nail unit and may occur alongside inflammation in a toe, finger, or other joint. A whole toe that becomes swollen can be a clue to inflammation beyond the nail itself.

Toenail changes do not by themselves confirm psoriatic arthritis. Fungal infection, injury from footwear, repeated pressure, eczema, and other nail problems can cause overlapping appearances. A clinician may examine the nail and skin, ask about joint pain, swelling, or morning stiffness, and arrange a nail sample or other tests when the diagnosis is uncertain. See more about [Psoriatic Arthritis](/conditions/psoriatic-arthritis/).

Arrange an appointment with a primary-care clinician, dermatologist, or rheumatology team if the nail change persists, several nails are affected, or you also have joint symptoms. Photograph the nails in good light and note when the change began, whether it follows an injury, and whether symptoms fluctuate.

Keep nails trimmed straight across, avoid cutting the cuticles, and choose footwear with enough room for the toes. Keep feet clean and dry, and do not share nail tools. Avoid starting steroid or antifungal treatment on the nail without advice, since the useful treatment depends on the cause. A clinician may discuss [Anti-Inflammatory Medication](/treatments/non-surgical-orthopedics/anti-inflammatory-medication/) or [Physiotherapy](/treatments/physiotherapy-and-rehabilitation/physiotherapy/) when joint inflammation is also present.

Seek prompt medical advice for a rapidly worsening or very painful nail, spreading redness, warmth, pus, fever, or difficulty walking. Contact a clinician sooner if a toe or joint becomes newly swollen, movement becomes restricted, or morning stiffness is affecting everyday activities. Severe pain after an injury, a dark mark that does not grow out, or bleeding without a clear cause also deserves assessment.

For related symptoms, read about [Joint Pain](/symptoms/joint-pain/), [Joint Swelling](/symptoms/joint-swelling/), and [Morning Joint Stiffness](/symptoms/morning-joint-stiffness/). Nail symptoms are not an emergency in many cases, but delaying evaluation can allow an infection or inflammatory joint problem to continue untreated.

Ask: Could this be psoriasis, psoriatic arthritis, a fungal infection, or damage from footwear? Do I need a nail sample or referral? Which joint or skin symptoms should I record? What nail care is safe while the diagnosis is being clarified? If joint inflammation is suspected, what treatment and movement plan would protect function?