Psoriasis is a chronic inflammatory disease; its causes are unknown but there is a genetic predisposition combined with triggers such as stress and trauma. This is referred to as psychosomatic pathology,meaning it can increase or decrease in intensity (meaning the amount and severity of symptoms) depending on the patient’s stress. It manifests as skin inflammation that results in a greatly accelerated turnover of keratin cells.
It mainly affects the skin, nails and joints.
Approximately 50% of ADULT patients with skin psoriasis also have nail involvement; in contrast, lamina affection in children drops to 10%.
What is nail psoriasis? How can it be recognized?
A nail with psoriasis is one that has altered color, texture, shape, and growth, and in addition to the lamina, the nail bed may also be affected.
It presents typical clinical signs:
- Pitting (large, deep, irregular domed depressions of the nail plate of several fingers especially of the hands)
- Onycholysis (the distal part of the nail plate is detached from its bed and bordered proaxially by a typical erythematous orb)
- Oil spot (small, irregular salmon-colored, round or oval, subungual, oil-drop-like spot due to psoriatic involvement of the nail bed).
- Perionysis (infection of periungual tissues).
- Hyperkeratosis of the nail bed (especially of the toenails)
- Splinter hemorrhages (thin, dark red longitudinal lines generally located in the distal portion of the nail plate).
Nail psoriasis is frequently associated with psoriatic arthropathy, a type of psoriasis that attacks joint tissue; often the two coexist, and diagnosis at the nail level allows the discovery of joint lesions.
A common complication in psoriasis of the hands and feet is inflammation and/or infection of the tissues surrounding the nail (perionyxis or vulgarly gyraditis), resulting from the nail’s increased susceptibility to dirt and microbes.
How to treat nail psoriasis
The treatment of nails with psoriasis is difficult; there is no cure but symptoms can be kept under control through applications of medication locally. If the involvement is very extensive, there are oral pharmacological alternatives.
Essential is care and cleaning of nails, frequent trimming and milling to prevent them from thickening.
Differential diagnosis is of paramount importance because the clinical presentation of the psoriatic nail is similar to that of other conditions that can affect the hands and feet.
First and foremost is onychomycosis, which is often self-diagnosed and treated unnecessarily with over-the-counter medications. The presence of mycosis is confirmed by mycological examination and should always be done when there is clinical doubt. The two conditions could coexist and may need to be fought on both fronts, which is why a visit to a podiatrist/dermatologist is important for proper diagnosis.
