What happens if nail psoriasis is not treated?

Inflammation can keep affecting the nail matrix or nail bed. The nail may become pitted, ridged, thickened or discoloured, and it can loosen from the skin underneath. Nail separation can allow debris to collect beneath the nail and may make everyday pressure uncomfortable. Changes often grow out slowly because a healthy-looking nail has to replace the affected portion.

Nail psoriasis can occur with psoriasis elsewhere on the skin, but nail changes can also be the main visible problem. A clinician can distinguish it from fungal infection or another nail disorder before choosing treatment. See the page on Nail Psoriasis or read about Nail Separation for related information.

Keep nails trimmed, avoid picking beneath a loosened nail, and wear gloves for prolonged contact with water or cleaning products. Reduce repeated trauma from manicures, biting and tight footwear. Photograph changes over time so a clinician can assess whether the condition is progressing.

Treatment depends on which nail structures are involved and how many nails are affected. Options may include a Steroid Injection Into The Skin for selected nails or Biologic Therapy when broader psoriasis needs treatment. A dermatologist should check for infection before starting or changing therapy.

Arrange an appointment if a nail is lifting, painful, increasingly thickened or changing colour, especially when the diagnosis is uncertain. Seek prompt care for spreading redness, warmth, swelling, drainage or severe pain around the nail, because these features can signal infection or another problem.

Could this be nail psoriasis, fungal infection or both? Which part of the nail is affected? How can I protect a separating nail? Would treatment for skin or joint psoriasis also help my nails? What changes should prompt an earlier review?