Severe psoriasis nails: what to know

Nail psoriasis may affect fingernails, toenails, or both. Small depressions, ridges, crumbly material beneath the nail, yellow-brown colour, thickening, and lifting from the nail bed are possible. The surrounding skin can be dry, red, scaly, cracked, itchy, or peeling. These changes can resemble a fungal infection, injury, or another nail disorder, so appearance alone cannot confirm the cause. Nail involvement may also occur alongside psoriasis elsewhere, and new finger or toe stiffness, swelling, or persistent joint pain deserves discussion because psoriasis can involve joints.

Keep nails short and file rough edges rather than pulling at lifted areas. Wear gloves for wet work and use moisturiser on the nail folds and hands. Avoid biting, aggressive manicures, artificial nails, and picking beneath the nail, which can worsen separation or injury. A dermatologist may inspect the nail, check for infection, and tailor treatment to the number of nails, discomfort, and any skin or joint symptoms. Read about [Psoriasis](/conditions/psoriasis/), [Dry Skin](/symptoms/dry-skin/), and [Scaly Skin](/symptoms/skin-scaling/) for related features.

Book an assessment when nail changes are extensive, painful, spreading, or interfering with walking, gripping, or daily tasks. Seek prompt care for increasing warmth, swelling, pus, severe tenderness, or a dark streak that is new or changing. New joint swelling or prolonged morning stiffness should also be reported rather than managed as a nail-only problem.

Could this be nail psoriasis, infection, or both? Do I need a nail sample or other examination? Which treatment is suitable for my nails and any skin disease? Should we assess joint symptoms, and how can I protect the nail bed while it grows?